Provider Demographics
NPI:1962659086
Name:BACUD, EDGAR QUINAGORAN (PT)
Entity type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:QUINAGORAN
Last Name:BACUD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 BROADMOOR LANE
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089
Mailing Address - Country:US
Mailing Address - Phone:214-206-6086
Mailing Address - Fax:
Practice Address - Street 1:4206 SOUTH FITZHUGH AVENUE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75210
Practice Address - Country:US
Practice Address - Phone:214-926-5319
Practice Address - Fax:972-412-4603
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1072247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB104213OtherTXB104213