Provider Demographics
NPI:1538176268
Name:BACSA, ERICSON SARIEGO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:ERICSON
Middle Name:SARIEGO
Last Name:BACSA
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:2701 S CARAWAY RD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7304
Mailing Address - Country:US
Mailing Address - Phone:870-919-4097
Mailing Address - Fax:870-910-0245
Practice Address - Street 1:2701 S CARAWAY RD
Practice Address - Street 2:SUITE B2
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7304
Practice Address - Country:US
Practice Address - Phone:870-919-4097
Practice Address - Fax:870-910-0245
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARPT 1409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U937OtherBC/BS