| Doctor Name: | MR. KENNETH MICHAEL JAGDMANN |
| NPI Number: | 1619959632 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RPT |
| License Number: | PT19655 |
| Business Practice Address: | 308 S Harbor City Blvd Suite B Melbourne, FL - 329011500 |
| Business Phone Number: | 3219512416 |
| Business Fax Number: | |
| Mailing Address: | 4117 N Us Highway 1, MELBOURNE |
| State: | FL |
| Postal Code: | 329354820 |
| Phone Number: | 3219512416 |
| Fax Number: | 3219512077 |
| NPI Enumeration Date: | 11/16/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT19655 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |