Provider Demographics
NPI:1023202629
Name:PAGKANLUNGAN, EDSEL
Entity Type:Individual
Prefix:
First Name:EDSEL
Middle Name:
Last Name:PAGKANLUNGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 DAVIS BLVD
Mailing Address - Street 2:APT 157
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-5331
Mailing Address - Country:US
Mailing Address - Phone:239-643-7879
Mailing Address - Fax:239-643-2951
Practice Address - Street 1:3940 RADIO RD
Practice Address - Street 2:SUITE 109
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34104-3740
Practice Address - Country:US
Practice Address - Phone:239-643-7879
Practice Address - Fax:239-643-2951
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0007692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY018NOtherBLUE CROSS/BLUE SHIELD
FLY018NOtherBLUE CROSS/BLUE SHIELD