Provider Demographics
NPI:1386295921
Name:LAGUERAS, KEVIN W (DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
Last Name:LAGUERAS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-0693
Mailing Address - Country:US
Mailing Address - Phone:585-851-9987
Mailing Address - Fax:866-299-5675
Practice Address - Street 1:4 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1445
Practice Address - Country:US
Practice Address - Phone:585-243-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044846225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist