Individual
PATRICIA MARIE FAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2175 N WHITLEY DR, FRUITLAND, ID 83619-2132
(208) 452-0303
Mailing address
7625 N NEVADA AVE, FRUITLAND, ID 83619-3559
(208) 739-0463
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1068
ID
Other
Enumeration date
10/02/2020
Last updated
10/02/2020
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