Carolyn W Fagan

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

#456 Issued in NM

Practice address

2954 Rodeo Park Dr W
Santa Fe, NM 87505-6351

Phone

(505) 424-0131

NPI assigned

Aug 14, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• New Mexico Sports & Physical Therapy

  • Physical Therapy Clinic/Center
  • Santa Fe, NM
  • NPI 1831242999
  NPD (past)
• New Mexico Sports & PT

  • Physical Therapy Clinic/Center
  • Santa Fe, NM
  • NPI 1427130137
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215940994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 CLEMATIS CIR",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875061292",
            "telephone_number": "505-424-0131",
            "fax_number": "505-424-1299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2954 RODEO PARK DR W",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875056351",
            "telephone_number": "505-424-0131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "CAROLYN",
        "middle_name": "W",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NM",
            "license": "#456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven C Eyre, M.D.
• Jordan Ezeanyim, PHARMD
• Tracy Fabre
• Karen E Factor, DOM
• Zoe Cheline Fadely
• Thomas Fagan, PT
• Corine J.O.M. Fairbanks
• Carl Collin Fairchild, PHARMD, DDS
• Maruan Fakhuri, L.M.T.
• Sarah Elizabeth Falion, MS, RD, LD

• Physical Therapy Clinic/Center in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Physical Therapy Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.