Healthcare Provider Details

I. General information

NPI: 1932110871
Provider Name (Legal Business Name): JEANETTE ELAINE FAGLIE L.P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S 1ST ST
TEMPLE TX
76504-7451
US

IV. Provider business mailing address

2002 STAGECOACH TRL
TEMPLE TX
76502-3222
US

V. Phone/Fax

Practice location:
  • Phone: 254-743-2250
  • Fax: 254-743-0313
Mailing address:
  • Phone: 254-743-2250
  • Fax: 254-743-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2015715
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: