Provider Demographics
NPI:1730392572
Name:DAGTA, NOEL (PT)
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:
Last Name:DAGTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 LEE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-4805
Mailing Address - Country:US
Mailing Address - Phone:239-369-3799
Mailing Address - Fax:
Practice Address - Street 1:1150 LEE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4805
Practice Address - Country:US
Practice Address - Phone:239-369-3799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist