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NPI Code Detail

MEDICARE: EDYTA JAGUSTIN P.T.

MEDICARE:   EDYTA  JAGUSTIN  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 Therapist5501006212MI

General Provider Information

NPI Number : 1457500829
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDYTA JAGUSTIN P.T.
Provider Business Mailing Address
First Line : 35735 MOUND RD
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48310-4728
Country : US
Telephone Number : 586-439-6258
Fax Number : 586-439-6240
Provider Business Practice Location Address
First Line : 35735 MOUND RD
Second Line :
City : STERLING HEIGHTS
State : MI
Zip : 48310-4728
Country : US
Telephone Number : 586-439-6258
Fax Number : 586-439-6240
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2008
Last Update Date : 06/18/2024

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Directions to “ EDYTA JAGUSTIN P.T.” Practice Location

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