Active NPI
Jared Michael Fagerstrom, DPT
- Physical Therapist
- Brockton, MA
National Provider Identifier
1306516984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 25734
- Practice address
- 940 Belmont St BLDG 2
Brockton, MA 02301-5568 - Phone
- (774) 826-1563
- NPI assigned
- Sep 15, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 25734 | MA | Primary |
Addresses
Primary practice location
940 Belmont St BLDG 2
Brockton, MA 02301-5568
Mailing address
44 S Gate Park
West Newton, MA 02465-1616
Phone (952) 836-6298
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25734 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631664000000",
"number": "1306516984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44 S GATE PARK",
"city": "WEST NEWTON",
"state": "MA",
"postal_code": "024651616",
"telephone_number": "952-836-6298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "940 BELMONT ST BLDG 2",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023015568",
"telephone_number": "774-826-1563"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGERSTROM",
"first_name": "JARED",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-09-15",
"last_updated": "2021-09-15",
"certification_date": "2021-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "25734",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.