Provider Demographics
NPI:1881175495
Name:BAGUIDY-EUGENE, ELIZABETH JACKIE (PT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JACKIE
Last Name:BAGUIDY-EUGENE
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 1:4010 PALMETTO TRL
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3820
Mailing Address - Country:US
Mailing Address - Phone:954-394-5397
Mailing Address - Fax:
Practice Address - Street 1:6931 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-4406
Practice Address - Country:US
Practice Address - Phone:954-583-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6794208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation