Individual
MRS. JADE ELISE FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3362 FOREST LN, DALLAS, TX 75234-7796
(972) 488-1300
(972) 488-1301
Mailing address
2936 ESTERBROOK DR, FARMERS BRANCH, TX 75234-4937
(217) 405-6853
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
1158980
TX
Other
Enumeration date
06/09/2011
Last updated
06/09/2011
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