Basic Information
| Provider Information | |||||||||
| NPI: | 1376946707 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LLAGUNO | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12171 SW 268TH ST | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330328001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052780200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2775 LAKE ALFRED RD | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338811432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632914590 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2014 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 4648 | KY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | 225700000X | MA24179 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
ID Information
| ID | Type | State | Issuer | Description | KY4648 | 01 | KY | KENTUCKY BOARD OF LICENSURE FOR MASSAGE THERAPY | OTHER | MA24179 | 01 | FL | FLORIDA BOARD OF OF LICENSURE FOR MASSAGE THERAPY | OTHER |