Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 037689 | NY |
Y | 225100000X | Physical Therapist | PT33115 | FL |
NPI | 1003222183 |
---|---|
Provider Name | Philip Lagamma |
First Address | Port Charlotte, FL 33952-9204 |
Second Address | Port Charlotte, FL 33952 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2014 |
Last Update Date | 14/10/2019 |