Provider Demographics
NPI:1205176104
Name:BAGLEY, CURTIS WARREN III (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:WARREN
Last Name:BAGLEY
Suffix:III
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26201 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7822
Mailing Address - Country:US
Mailing Address - Phone:239-498-0558
Mailing Address - Fax:239-498-0557
Practice Address - Street 1:26201 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7822
Practice Address - Country:US
Practice Address - Phone:239-498-0558
Practice Address - Fax:239-498-0557
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 27931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 27931OtherFLORIDA STATE PHYSICAL THERAPIST LICENSE