Basic Information
| Provider Information | |||||||||
| NPI: | 1275860546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEQUINA | ||||||||
| FirstName: | JOSAFEENA | ||||||||
| MiddleName: | LAGMAN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1920 OLD SPRINGVILLE RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CENTER POINT | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352155858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189109010 | ||||||||
| FaxNumber: | 2055200455 | ||||||||
| Practice Location | |||||||||
| Address1: | 1920 OLD SPRINGVILLE RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CENTER POINT | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352155858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189109010 | ||||||||
| FaxNumber: | 2055200455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2009 | ||||||||
| LastUpdateDate: | 11/06/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2009032154 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.