Healthcare Provider Details

I. General information

NPI: 1467520155
Provider Name (Legal Business Name): ERIC L GAHAGAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WEST AVENUE
LE ROY NY
14482
US

IV. Provider business mailing address

16 ROSS STREET UPPER
BATAVIA NY
14020
US

V. Phone/Fax

Practice location:
  • Phone: 585-768-4550
  • Fax: 585-768-2335
Mailing address:
  • Phone: 585-409-5501
  • Fax: 585-768-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0264521
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: