Provider Demographics
NPI:1447389424
Name:FAGAN, JEANNEMARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:JEANNEMARIE
Middle Name:
Last Name:FAGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6851 S HOLLY CIR STE 290
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1076
Mailing Address - Country:US
Mailing Address - Phone:303-542-8737
Mailing Address - Fax:
Practice Address - Street 1:6851 S HOLLY CIR STE 290
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1076
Practice Address - Country:US
Practice Address - Phone:303-542-8737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist