Provider Demographics
NPI:1942626288
Name:LAGUNA, KIM (PTA, CLT)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:LAGUNA
Suffix:
Gender:F
Credentials:PTA, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14655 VIA TIVOLI CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6917
Mailing Address - Country:US
Mailing Address - Phone:754-422-7316
Mailing Address - Fax:
Practice Address - Street 1:303 SW 6TH STREET
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315
Practice Address - Country:US
Practice Address - Phone:754-422-7316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X174400000X
225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No174400000XOther Service ProvidersSpecialist