Provider Demographics
NPI:1144429531
Name:GAGNON, LINDA LEE
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LEE
Last Name:GAGNON
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 1:4349 FORT SHAW DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-7316
Mailing Address - Country:US
Mailing Address - Phone:727-278-5690
Mailing Address - Fax:727-372-0970
Practice Address - Street 1:4349 FORT SHAW DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-7316
Practice Address - Country:US
Practice Address - Phone:727-278-5690
Practice Address - Fax:727-372-0970
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 10723225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist