Bagley, Dale Glen
Bagley, Dale Glen is an individual health care provider with primary practice located at 2513 Ridge Runner Rd , Las Vegas NM 87701-4972. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Bagley, Dale Glen can be contacted via phone (505) 425-1117.Contact Information
Primary practice address
2513 Ridge Runner Rd
Las Vegas NM 87701-4972
Phone: (505) 425-1117
Fax: (505) 454-7810
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X |
Profile Details
| NPI number | 1568470995 |
|---|---|
| LBN Legal business name | Bagley, Dale Glen |
| Credentials | Physical Therapist (PT) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 3rd, 2006 |
| Last updated | Jul 24th, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568470995 | NPPES |
| New Mexico | MEDICAID | 000N5640 | |
| New Mexico | Other | 00NM00Q089 |
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