Healthcare Provider Details

I. General information

NPI: 1275860546
Provider Name (Legal Business Name): JOSAFEENA LAGMAN DEQUINA RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 OLD SPRINGVILLE RD SUITE 104
CENTER POINT AL
35215-5858
US

IV. Provider business mailing address

1920 OLD SPRINGVILLE RD SUITE 104
CENTER POINT AL
35215-5858
US

V. Phone/Fax

Practice location:
  • Phone: 618-910-9010
  • Fax: 205-520-0455
Mailing address:
  • Phone: 618-910-9010
  • Fax: 205-520-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2009032154
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: