Provider Demographics
NPI:1467520155
Name:GAHAGAN, ERIC L (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:L
Last Name:GAHAGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ROSS STREET UPPER
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020
Mailing Address - Country:US
Mailing Address - Phone:585-409-5501
Mailing Address - Fax:585-768-2335
Practice Address - Street 1:3 WEST AVENUE
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482
Practice Address - Country:US
Practice Address - Phone:585-768-4550
Practice Address - Fax:585-768-2335
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0264521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA8124Medicare ID - Type Unspecified