Provider Demographics
NPI:1891867792
Name:LAGUARDIA, JAN POWERS (PT)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:POWERS
Last Name:LAGUARDIA
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:PO BOX 894
Mailing Address - Street 2:
Mailing Address - City:ORIENTAL
Mailing Address - State:NC
Mailing Address - Zip Code:28571-0894
Mailing Address - Country:US
Mailing Address - Phone:252-249-1051
Mailing Address - Fax:252-249-0112
Practice Address - Street 1:1006 BROAD STREET
Practice Address - Street 2:
Practice Address - City:ORIENTAL
Practice Address - State:NC
Practice Address - Zip Code:28571
Practice Address - Country:US
Practice Address - Phone:252-249-1051
Practice Address - Fax:252-249-0112
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078JJOtherBLUE CROSS BLUE SHIELD
NC078JJOtherBLUE CROSS BLUE SHIELD