Provider Demographics
NPI:1689784662
Name:LAGOWSKI, NANCY G (PTA)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:G
Last Name:LAGOWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:G
Other - Last Name:LAGOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CMT
Mailing Address - Street 1:5550 KIRKWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5002
Mailing Address - Country:US
Mailing Address - Phone:302-995-2100
Mailing Address - Fax:302-998-3104
Practice Address - Street 1:5550 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5002
Practice Address - Country:US
Practice Address - Phone:302-995-2100
Practice Address - Fax:302-998-3104
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ20000273225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant