Healthcare Provider Details

I. General information

NPI: 1497229959
Provider Name (Legal Business Name): SUZANNE FAGNANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2019
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 GOSLING RD
SPRING TX
77381-3596
US

IV. Provider business mailing address

2 RYANWYCK PL
THE WOODLANDS TX
77384-4767
US

V. Phone/Fax

Practice location:
  • Phone: 281-296-9234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: