Provider Demographics
NPI:1164752598
Name:PARGUIAN, IVANOVA S (PT)
Entity Type:Individual
Prefix:
First Name:IVANOVA
Middle Name:S
Last Name:PARGUIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:IVANOVA
Other - Middle Name:GLINOGA
Other - Last Name:PARGUIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:3723 RUSHING WATERS DR
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-8139
Mailing Address - Country:US
Mailing Address - Phone:321-506-7441
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:4280 MINTON RD STE 120
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-9564
Practice Address - Country:US
Practice Address - Phone:951-696-9353
Practice Address - Fax:951-973-7216
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT25232OtherPT LICENSURE