Provider Demographics
NPI:1386961878
Name:GALARZA, DAGNA IVELISSE (PT)
Entity type:Individual
Prefix:MRS
First Name:DAGNA
Middle Name:IVELISSE
Last Name:GALARZA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 NW 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-2263
Mailing Address - Country:US
Mailing Address - Phone:352-376-1320
Mailing Address - Fax:352-376-1340
Practice Address - Street 1:2730 NW 39TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-2263
Practice Address - Country:US
Practice Address - Phone:352-376-1320
Practice Address - Fax:352-376-1340
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist