Provider Demographics
NPI:1902825284
Name:KAGAN, BARBARA (PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:KAGAN
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 1:932 PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2220
Mailing Address - Country:US
Mailing Address - Phone:310-453-8819
Mailing Address - Fax:310-315-9349
Practice Address - Street 1:1482 PALISADES DR
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-2161
Practice Address - Country:US
Practice Address - Phone:310-453-8819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PT8548Medicare ID - Type Unspecified