Doctor Name: | DAVE SPENCER MAYUELA TABOADA |
NPI Number: | 1255426144 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHYSICAL THERAPIST |
License Number: | 05007580A |
Business Practice Address: | 403 N Glendale Ave Apt 103 Tomah, WI - 546601322 |
Business Phone Number: | 6083723971 |
Business Fax Number: | |
Mailing Address: | 403 N Glendale Ave Apt 103, TOMAH |
State: | WI |
Postal Code: | 546601322 |
Phone Number: | 6083723971 |
Fax Number: | |
NPI Enumeration Date: | 10/04/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 05007580A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |