Provider Demographics
NPI:1821683038
Name:AGAN, BILLIE JOELLE (PTA, CPT)
Entity Type:Individual
Prefix:MS
First Name:BILLIE
Middle Name:JOELLE
Last Name:AGAN
Suffix:
Gender:F
Credentials:PTA, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CORINTH POSEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110-3118
Mailing Address - Country:US
Mailing Address - Phone:770-312-5327
Mailing Address - Fax:
Practice Address - Street 1:4 HAZEL AVE
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4706
Practice Address - Country:US
Practice Address - Phone:203-723-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2156225200000X
GAPTA004521225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant