Provider Demographics
NPI:1154397107
Name:DAGOSTINO, JAMES JOSEPH (DPT PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOSEPH
Last Name:DAGOSTINO
Suffix:
Gender:M
Credentials:DPT PT
Other - Prefix:
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Mailing Address - Street 1:3809 PLAZA DR
Mailing Address - Street 2:STE 112
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4625
Mailing Address - Country:US
Mailing Address - Phone:760-941-2630
Mailing Address - Fax:760-941-4617
Practice Address - Street 1:3809 PLAZA DR
Practice Address - Street 2:STE 112
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4625
Practice Address - Country:US
Practice Address - Phone:760-941-2630
Practice Address - Fax:760-941-4617
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT6791AMedicare ID - Type Unspecified
CAPT6791Medicare UPIN