Provider Demographics
NPI:1144455338
Name:LAUGAVITZ, PATRICIA (PTA)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:LAUGAVITZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:LAUGAVITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:7104 E CALYPSO LOOP
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-1309
Mailing Address - Country:US
Mailing Address - Phone:352-302-5286
Mailing Address - Fax:
Practice Address - Street 1:7104 E CALYPSO LOOP
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-1309
Practice Address - Country:US
Practice Address - Phone:352-302-5286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA001441225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106898OtherMEDICARE ID