Individual
MR. DALE GLEN BAGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2513 RIDGE RUNNER RD, LAS VEGAS, NM 87701-4972
(505) 425-1117
(505) 454-7810
Mailing address
2513 RIDGE RUNNER RD, LAS VEGAS, NM 87701-4972
(505) 425-1117
(505) 454-7810
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000N5640
—
NM
01
—
00NM00Q089
BLUE CROSS BLUE SHIELD
NM
Enumeration date
08/03/2006
Last updated
07/24/2008
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