Provider Demographics
NPI:1154396851
Name:LLAGUNO, ANDREW S (MSED ATC CSCS)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:S
Last Name:LLAGUNO
Suffix:
Gender:M
Credentials:MSED ATC CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:97C SAND PLAIN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02813-3837
Mailing Address - Country:US
Mailing Address - Phone:401-364-8066
Mailing Address - Fax:
Practice Address - Street 1:3 KEANEY RD
Practice Address - Street 2:SUITE ONE
Practice Address - City:KINGSTON
Practice Address - State:RI
Practice Address - Zip Code:02881-1111
Practice Address - Country:US
Practice Address - Phone:401-874-5230
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI1392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer