Basic Information
| Provider Information | |||||||||
| NPI: | 1386803930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MRUGALA | ||||||||
| FirstName: | DARIUSZ | ||||||||
| MiddleName: | ADAM | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1133 NW RENFRO ST | ||||||||
| Address2: | |||||||||
| City: | BURLESON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760283333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172011495 | ||||||||
| FaxNumber: | 8174472238 | ||||||||
| Practice Location | |||||||||
| Address1: | 1133 NW RENFRO ST | ||||||||
| Address2: | |||||||||
| City: | BURLESON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760283333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172011495 | ||||||||
| FaxNumber: | 8174472238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2008 | ||||||||
| LastUpdateDate: | 06/07/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1079218 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.