MEDICARE: MRS. JULIE R AGAN PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2747	NC

General Provider Information

NPI Number	:	1437483294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE R AGAN PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	3403 CARRIAGE FARM RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-8326
Country	:	US
Telephone Number	:	252-937-0177
Fax Number	:

Provider Business Practice Location Address
First Line	:	3403 CARRIAGE FARM RD
Second Line	:
City	:	ROCKY MOUNT
State	:	NC
Zip	:	27804-8326
Country	:	US
Telephone Number	:	252-937-0177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2009
Last Update Date	:	09/28/2009

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