Healthcare Provider Details

I. General information

NPI: 1386924710
Provider Name (Legal Business Name): TERESA ELISENDA AAGAARD P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 SANTA ROSA RD
CAMARILLO CA
93012-7101
US

IV. Provider business mailing address

6334 CORTE LUCINDA
CAMARILLO CA
93012-8199
US

V. Phone/Fax

Practice location:
  • Phone: 805-388-8086
  • Fax:
Mailing address:
  • Phone: 727-808-3585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number9593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: