Healthcare Provider Details

I. General information

NPI: 1932233848
Provider Name (Legal Business Name): TAMMY LOUISE LAGASSE P.T.A., L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4075 A1A S SUITE 105
ST AUGUSTINE FL
32080-6773
US

IV. Provider business mailing address

4075 A1A S SUITE 105
ST AUGUSTINE FL
32080-6773
US

V. Phone/Fax

Practice location:
  • Phone: 904-471-2999
  • Fax:
Mailing address:
  • Phone: 904-471-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA15835
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA39295
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMM16788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: