Healthcare Provider Details

I. General information

NPI: 1841822525
Provider Name (Legal Business Name): FAGAN GERIATRIC WELLNESS AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 E PRINCE ST
GALLATIN TN
37066-2880
US

IV. Provider business mailing address

2026A HIGHWAY 31 W
WHITE HOUSE TN
37188-8960
US

V. Phone/Fax

Practice location:
  • Phone: 615-334-6983
  • Fax: 615-581-0245
Mailing address:
  • Phone: 615-533-2354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE FAGAN
Title or Position: COO, PT
Credential: PT, GTCCS, GCS
Phone: 615-334-6983