MEDICARE: FRANCES LASTICA AGUILAR 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	PT60127396	WA
2	225100000X	Physical Therapist	2305207648	VA
3	225100000X	Physical Therapist	24322	MD
4	225100000X	Physical Therapist	PT30756	FL

General Provider Information

NPI Number	:	1336584788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANCES LASTICA AGUILAR PT

Provider Business Mailing Address
First Line	:	52 ABACUS AVE
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-1047
Country	:	US
Telephone Number	:	425-306-1856
Fax Number	:

Provider Business Practice Location Address
First Line	:	52 ABACUS AVE
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-1047
Country	:	US
Telephone Number	:	425-306-1856
Fax Number	:

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

Provider Enumeration Date	:	04/29/2013
Last Update Date	:	07/15/2016

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