MEDICARE: CLAUDIA ELENA D'AGOSTINO PT

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
1	225100000X	Physical Therapist	7148	FL

General Provider Information

NPI Number	:	1326328428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAUDIA ELENA D'AGOSTINO PT

Provider Business Mailing Address
First Line	:	550 SW 3RD ST
Second Line	:	201
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6934
Country	:	US
Telephone Number	:	954-941-1708
Fax Number	:	954-941-1708

Provider Business Practice Location Address
First Line	:	550 SW 3RD ST
Second Line	:	201
City	:	POMPANO BEACH
State	:	FL
Zip	:	33060-6934
Country	:	US
Telephone Number	:	954-941-1708
Fax Number	:	954-941-1708

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	08/19/2011

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