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NPI Code Detail

MEDICARE: LAURA JANE BAGWELL

MEDICARE: LAURA JANE BAGWELL
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 Therapist2305210453VA
2225100000XPhysical TherapistP24080NC

General Provider Information

NPI Number : 1730632555
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA JANE BAGWELL
Provider Business Mailing Address
First Line : 2122 YORK RD STE 300
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-1925
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 510 TIMBER DR E STE 102
Second Line :
City : GARNER
State : NC
Zip : 27529-5285
Country : US
Telephone Number : 919-500-5003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2016
Last Update Date : 06/24/2025

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Directions to “ LAURA JANE BAGWELL ” Practice Location

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