| Doctor Name: | MRS. NICOLE J DEVERTEUIL-WAGGONER |
| NPI Number: | 1992798607 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | PT18177 |
| Business Practice Address: | 12341 Nw 18th St Plantation, FL - 333232122 |
| Business Phone Number: | 9544784648 |
| Business Fax Number: | 9545305694 |
| Mailing Address: | 8100 Nw 101st Ave, TAMARAC |
| State: | FL |
| Postal Code: | 333211235 |
| Phone Number: | 9542580415 |
| Fax Number: | 9547186046 |
| NPI Enumeration Date: | 08/27/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT18177 |
| 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 |