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NPI Code Detail

MEDICARE: IVANOVA S PARGUIAN P.T.

MEDICARE:   IVANOVA S PARGUIAN  P.T.
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 Therapist25232FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT25232OTHERFLPT LICENSURE

General Provider Information

NPI Number : 1164752598
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVANOVA S PARGUIAN P.T.
Provider Business Mailing Address
First Line : 3723 RUSHING WATERS DR
Second Line :
City : WEST MELBOURNE
State : FL
Zip : 32904-8139
Country : US
Telephone Number : 321-506-7441
Fax Number : 951-973-7216
Provider Business Practice Location Address
First Line : 4280 MINTON RD STE 120
Second Line :
City : WEST MELBOURNE
State : FL
Zip : 32904-9564
Country : US
Telephone Number : 951-696-9353
Fax Number : 951-973-7216
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2010
Last Update Date : 07/21/2022

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Directions to “ IVANOVA S PARGUIAN P.T.” Practice Location

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