Healthcare Provider Details

I. General information

NPI: 1275658940
Provider Name (Legal Business Name): PAUL JOSEPH GAGNE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MOUNT AIRYSHIRE BLVD
COLUMBUS OH
43235-1364
US

IV. Provider business mailing address

241 WILLOWDOWN CT
COLUMBUS OH
43235-7027
US

V. Phone/Fax

Practice location:
  • Phone: 614-888-7288
  • Fax:
Mailing address:
  • Phone: 419-290-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7600
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number014372
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: