Individual
CHERI LEIGH FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
221 W TAMARACK ST, PINDAR PHYSICAL THERAPY INC, HAZLETON, PA 18201
(570) 401-6566
(570) 501-2435
Mailing address
PO BOX 384, 306 EAST 1ST ST, MIFFLINVILLE, PA 18631
(570) 752-4744
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
OC006277L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00298278
RAILROAD MEDICARE
—
Enumeration date
02/09/2007
Last updated
07/08/2007
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