Provider Demographics
NPI:1497958011
Name:GAGLIANO, JEANNINE (LMT)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:
Last Name:GAGLIANO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 MIDDLEBROOK RD
Mailing Address - Street 2:#825
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-6783
Mailing Address - Country:US
Mailing Address - Phone:407-719-5421
Mailing Address - Fax:
Practice Address - Street 1:4140 MIDDLEBROOK RD
Practice Address - Street 2:#825
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-6783
Practice Address - Country:US
Practice Address - Phone:407-719-5421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA29736225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist