Individual
FREDERICK BACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1008 MINNEQUA AVE, PUEBLO, CO 81004
(719) 560-5417
(719) 560-4750
Mailing address
DEPARTMENT 1188, DENVER, CO 80291-1188
(303) 486-5500
(303) 486-5502
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
02/14/2008
Last updated
02/14/2008
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