Provider Demographics
NPI:1023328622
Name:PAGANO, RICHARD SEBASTIAN (PT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SEBASTIAN
Last Name:PAGANO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E TERRA LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-4414
Mailing Address - Country:US
Mailing Address - Phone:636-978-6634
Mailing Address - Fax:
Practice Address - Street 1:1601 E TERRA LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4414
Practice Address - Country:US
Practice Address - Phone:636-978-6634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113783225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist