Individual
THOMAS FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2954 RODEO PARK DR W, SANTA FE, NM 87505-6351
(505) 424-0131
(505) 424-1299
Mailing address
PO BOX 6100, SANTA FE, NM 87502-6100
(505) 424-0134
(505) 424-1299
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
#430
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
N4536
—
NM
Enumeration date
08/16/2006
Last updated
06/07/2011
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