Provider Demographics
NPI:1427220003
Name:KAGEFF, LAURA J (LMT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:KAGEFF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 S PALM AIRE DR
Mailing Address - Street 2:# 208
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4280
Mailing Address - Country:US
Mailing Address - Phone:954-917-7575
Mailing Address - Fax:954-917-7576
Practice Address - Street 1:3301 S PALM AIRE DR
Practice Address - Street 2:# 208
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4280
Practice Address - Country:US
Practice Address - Phone:954-917-7575
Practice Address - Fax:954-917-7576
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 24120225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist