Healthcare Provider Details

I. General information

NPI: 1134837693
Provider Name (Legal Business Name): CAROL ANN LAGANA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 OFFICE PARK DR STE 4
PALM COAST FL
32137-3831
US

IV. Provider business mailing address

8 RIPPLE PL
PALM COAST FL
32164-6514
US

V. Phone/Fax

Practice location:
  • Phone: 386-387-9719
  • Fax:
Mailing address:
  • Phone: 386-387-9719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA28606
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: