Healthcare Provider Details

I. General information

NPI: 1598250326
Provider Name (Legal Business Name): KAYLAN LEIGH FAGLEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 HILLTOP DR
WEATHERFORD TX
76086-5845
US

IV. Provider business mailing address

6501 HARRIS PKWY
FORT WORTH TX
76132-6102
US

V. Phone/Fax

Practice location:
  • Phone: 817-594-7636
  • Fax:
Mailing address:
  • Phone: 817-370-9891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1304258
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: