Provider Demographics
NPI:1821234162
Name:FAGAN, HEIDI LYNN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:LYNN
Last Name:FAGAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 WAYLAND RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-2307
Mailing Address - Country:US
Mailing Address - Phone:610-325-4903
Mailing Address - Fax:610-325-2925
Practice Address - Street 1:2600 WAYLAND RD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-2307
Practice Address - Country:US
Practice Address - Phone:610-325-4903
Practice Address - Fax:610-325-2925
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012109L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist