Provider Demographics
NPI:1043933880
Name:LAGMAN, MIKAELA ADRIANO (DPT)
Entity Type:Individual
Prefix:
First Name:MIKAELA
Middle Name:ADRIANO
Last Name:LAGMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98120 QUEENS BLVD STE 1LM
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4357
Mailing Address - Country:US
Mailing Address - Phone:718-897-3333
Mailing Address - Fax:718-997-0342
Practice Address - Street 1:98120 QUEENS BLVD STE 1LM
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4357
Practice Address - Country:US
Practice Address - Phone:718-897-3333
Practice Address - Fax:718-997-0342
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2024-04-21
Deactivation Date:2023-05-01
Deactivation Code:
Reactivation Date:2024-04-10
Provider Licenses
StateLicense IDTaxonomies
NY048301-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist