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NPI Code Detail

MEDICARE: MS. ERICA GAGNE DPT

MEDICARE: MS. ERICA GAGNE DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist25698FL

General Provider Information

NPI Number : 1376853820
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ERICA GAGNE DPT
Provider Business Mailing Address
First Line : 2480 N PARK ROAD
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33021
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2480 N PARK RD
Second Line :
City : HOLLYWOOD
State : FL
Zip : 33021-3744
Country : US
Telephone Number : 954-981-0584
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2010
Last Update Date : 10/18/2010

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