Provider Demographics
NPI:1679905988
Name:AGAN, BRIAN J (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:AGAN
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 1:3403 CARRIAGE FARM RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8326
Mailing Address - Country:US
Mailing Address - Phone:252-937-0177
Mailing Address - Fax:
Practice Address - Street 1:3403 CARRIAGE FARM RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8326
Practice Address - Country:US
Practice Address - Phone:252-937-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6692251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic