Provider Demographics
NPI:1902954167
Name:PAGILLO, BARBARA ORR (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ORR
Last Name:PAGILLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 LONGLEAF DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4322
Mailing Address - Country:US
Mailing Address - Phone:678-860-8289
Mailing Address - Fax:770-642-7096
Practice Address - Street 1:460 LONGLEAF DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4322
Practice Address - Country:US
Practice Address - Phone:678-860-8289
Practice Address - Fax:770-642-7096
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004842225100000X
GAPCET001860235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000696154BMedicaid
GA909868810DMedicaid