Provider Demographics
NPI:1255360988
Name:BAGASAN, MILALYNN B (PT)
Entity type:Individual
Prefix:MRS
First Name:MILALYNN
Middle Name:B
Last Name:BAGASAN
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 1:3521 W BOYNTON BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4533
Mailing Address - Country:US
Mailing Address - Phone:561-732-2422
Mailing Address - Fax:561-732-2420
Practice Address - Street 1:3521 W BOYNTON BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-4533
Practice Address - Country:US
Practice Address - Phone:561-732-2422
Practice Address - Fax:561-732-2420
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist