Provider Demographics
NPI:1033675731
Name:AGANON, LOVELLYN SAGSAGAT
Entity Type:Individual
Prefix:
First Name:LOVELLYN
Middle Name:SAGSAGAT
Last Name:AGANON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11171 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8054
Mailing Address - Country:US
Mailing Address - Phone:219-869-1197
Mailing Address - Fax:
Practice Address - Street 1:11171 OHIO ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8054
Practice Address - Country:US
Practice Address - Phone:219-869-1197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist