Provider Demographics
NPI:1841822525
Name:FAGAN GERIATRIC WELLNESS AND REHABILITATION
Entity type:Organization
Organization Name:FAGAN GERIATRIC WELLNESS AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO, PT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, GTCCS, GCS
Authorized Official - Phone:615-334-6983
Mailing Address - Street 1:2026A HIGHWAY 31 W
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188-8960
Mailing Address - Country:US
Mailing Address - Phone:615-533-2354
Mailing Address - Fax:
Practice Address - Street 1:143 E PRINCE ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2880
Practice Address - Country:US
Practice Address - Phone:615-334-6983
Practice Address - Fax:615-581-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy