MEDICARE: LAURA FAHEY PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	34688	CA

General Provider Information

NPI Number	:	1669421087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA FAHEY PT, DPT

Provider Business Mailing Address
First Line	:	8410 DERFER DR
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-5462
Country	:	US
Telephone Number	:	315-345-8741
Fax Number	:

Provider Business Practice Location Address
First Line	:	3111 SANTA ANITA AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91733-1357
Country	:	US
Telephone Number	:	626-443-0218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	06/10/2019

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Directions to “ LAURA FAHEY PT, DPT” Practice Location

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