Individual
MR. VAGNER CARVALHO DACHAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA, OPTA
Contact information
Practice address
1201 E OCEAN AVE, LOMPOC, CA 93436-7081
(805) 735-8365
Mailing address
9642 WASHINGTON AVE, LAUREL, MD 20723-1870
(301) 300-8136
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
2142830
TX
225200000X
Physical Therapy Assistant
49677
CA
225200000X
Physical Therapy Assistant
Primary
A4396
MD
Other
Enumeration date
09/12/2019
Last updated
09/12/2019
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