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Individual
MR. PAUL BACON
Active
Individual
MR. PAUL BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1124006
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124006
LICENSE
TX
Enumeration date
10/31/2006
Last updated
07/08/2014
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