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General NPI Number Information
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NPI Number | 1841822525
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Entity Type | Organization
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Legal Business Name | FAGAN GERIATRIC WELLNESS AND REHABILITATION
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 143 E PRINCE ST
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City | GALLATIN
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State | TN
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Zip | 37066-2880
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Country | US
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Telephone | 615-334-6983
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Fax | 615-581-0245
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Provider Business Mailing Address
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Address Line | 2026A HIGHWAY 31 W
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City | WHITE HOUSE
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State | TN
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Zip | 37188-8960
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Country | US
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Telephone | 615-533-2354
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Fax |
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Authorized Official
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Title or Position | COO, PT
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Name | KATHERINE FAGAN
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Credential | PT, GTCCS, GCS
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Telephone | 615-334-6983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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