Provider Demographics
NPI:1285497644
Name:AGUILAR, CARLOS A (PTA)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 NW DUNSTAN LN
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3100
Mailing Address - Country:US
Mailing Address - Phone:915-843-2211
Mailing Address - Fax:
Practice Address - Street 1:2640 MINER RD
Practice Address - Street 2:
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-4437
Practice Address - Country:US
Practice Address - Phone:580-585-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2111260225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant