Healthcare Provider Details

I. General information

NPI: 1588874341
Provider Name (Legal Business Name): TIMOTHY FAGERSON PT, DPT, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 LINDEN ST STE B-8, SOSPT, INC.
WELLESLEY MA
02482-7900
US

IV. Provider business mailing address

148 LINDEN ST STE B-8, SOSPT, INC.
WELLESLEY MA
02482-7900
US

V. Phone/Fax

Practice location:
  • Phone: 781-263-9977
  • Fax:
Mailing address:
  • Phone: 781-263-9977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8253
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: