Provider Demographics
NPI:1497077549
Name:FRAGOMAN, RENEE RACHELLE (BS)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:RACHELLE
Last Name:FRAGOMAN
Suffix:
Gender:F
Credentials:BS
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Mailing Address - Street 1:1 COLLEGE CIR
Mailing Address - Street 2:SUNY GENESEO - HOLCOMB BUILDING
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-1401
Mailing Address - Country:US
Mailing Address - Phone:585-245-5688
Mailing Address - Fax:585-245-5685
Practice Address - Street 1:1 COLLEGE CIR
Practice Address - Street 2:SUNY GENESEO - HOLCOMB BUILDING
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1401
Practice Address - Country:US
Practice Address - Phone:585-245-5688
Practice Address - Fax:585-245-5685
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY019079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist