Provider Demographics
NPI:1003954728
Name:LAGREGA, KIMBERLY (PT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:LAGREGA
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 1:86 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2018
Mailing Address - Country:US
Mailing Address - Phone:631-803-0779
Mailing Address - Fax:
Practice Address - Street 1:86 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2018
Practice Address - Country:US
Practice Address - Phone:631-803-0779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist