Provider Demographics
NPI:1568840700
Name:VASGAR, CATHERINE (PTA)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:VASGAR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6257 CLARET DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7702
Mailing Address - Country:US
Mailing Address - Phone:904-314-2855
Mailing Address - Fax:
Practice Address - Street 1:6257 CLARET DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7702
Practice Address - Country:US
Practice Address - Phone:904-314-2855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11422A225200000X
OR09598225200000X
FL25064225200000X
NMA-1107225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant