Provider Demographics
NPI:1174677983
Name:JAGUSZTYN, VANESSA MAGNOLIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MAGNOLIA
Last Name:JAGUSZTYN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2304 S CYPRESS BEND DR
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4498
Mailing Address - Country:US
Mailing Address - Phone:814-715-9101
Mailing Address - Fax:
Practice Address - Street 1:1800 W WOOLBRIGHT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6398
Practice Address - Country:US
Practice Address - Phone:561-733-7677
Practice Address - Fax:561-733-7074
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist