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Individual

MR. EDSEL LIGUTOM JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
1400 LAKE SHORE DR, WACO, TX 76708-3718
(254) 753-0291
Mailing address
2817 SHERCO RD, LORENA, TX 76655-4097

Taxonomy

Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
1293040
TX

Other

Enumeration date
10/21/2025
Last updated
10/21/2025
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