Provider Demographics
NPI:1306095310
Name:CACHO, RAYMOND ORDINARIA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:ORDINARIA
Last Name:CACHO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Mailing Address - Street 1:2001 CONNECTICUT AVE
Mailing Address - Street 2:APT D2
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1108
Mailing Address - Country:US
Mailing Address - Phone:417-659-9656
Mailing Address - Fax:
Practice Address - Street 1:2001 CONNECTICUT AVE
Practice Address - Street 2:APT D2
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1108
Practice Address - Country:US
Practice Address - Phone:417-659-9656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070016689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist