Provider Demographics
NPI:1386924710
Name:AAGAARD, TERESA ELISENDA (PTA)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ELISENDA
Last Name:AAGAARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6334 CORTE LUCINDA
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8199
Mailing Address - Country:US
Mailing Address - Phone:727-808-3585
Mailing Address - Fax:
Practice Address - Street 1:6000 SANTA ROSA RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-7101
Practice Address - Country:US
Practice Address - Phone:805-388-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9593225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9593OtherCALIFORNIA PHYSICAL THERAPY BOARD