Provider Demographics
NPI:1225378185
Name:VERGAUWEN, MAGDALENA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MAGDALENA
Middle Name:
Last Name:VERGAUWEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N SWEETWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-2512
Mailing Address - Country:US
Mailing Address - Phone:407-575-9137
Mailing Address - Fax:
Practice Address - Street 1:103 N SWEETWATER BLVD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2512
Practice Address - Country:US
Practice Address - Phone:407-575-9137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist