Provider Demographics
NPI:1942631148
Name:LAGMAN, CALVIN LUTHER GAVILAN (PT)
Entity Type:Individual
Prefix:
First Name:CALVIN LUTHER
Middle Name:GAVILAN
Last Name:LAGMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 HARVEY MITCHELL PKWY S
Mailing Address - Street 2:APARTMENT 204
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-5257
Mailing Address - Country:US
Mailing Address - Phone:979-481-7029
Mailing Address - Fax:
Practice Address - Street 1:12124 HIGH TECH AVE STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-8374
Practice Address - Country:US
Practice Address - Phone:800-774-7785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1238640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist