Individual
ANDREA G FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
99 E STATE ST, GLOVERSVILLE, NY 12078-1203
(518) 773-5625
Mailing address
99 E STATE ST, GLOVERSVILLE, NY 12078-1203
(518) 773-5625
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
012288-01
NY
Other
Enumeration date
02/11/2020
Last updated
02/11/2020
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