Provider Demographics
NPI:1821209586
Name:FAGAN, KERRY A (PT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:FAGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:A
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:16 HAYDEN AVE
Mailing Address - Street 2:LAHEY LEXINGTON
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7929
Mailing Address - Country:US
Mailing Address - Phone:781-372-7060
Mailing Address - Fax:781-372-7069
Practice Address - Street 1:16 HAYDEN AVE
Practice Address - Street 2:LAHEY LEXINGTON
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7929
Practice Address - Country:US
Practice Address - Phone:781-372-7060
Practice Address - Fax:781-372-7069
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist