Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT-4109 | HI |
NPI | 1043673296 |
---|---|
Provider Name | Athena Lynn Lagundi |
First Address | Waipahu, HI 96797-0277 |
Second Address | Waipahu, HI 96797-3031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2016 |
Last Update Date | 04/04/2016 |