Individual
IAN BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4510 27TH ST, LUBBOCK, TX 79410-1709
(806) 795-4368
Mailing address
4510 27TH ST, LUBBOCK, TX 79410-1709
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2125070
TX
Other
Enumeration date
02/16/2017
Last updated
02/16/2017
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