Active NPI
Molly Fagen, PT
- Physical Therapist
- Gainesville, FL
National Provider Identifier
1699263616
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT31978
- Practice address
- 4842 SW Archer Rd
Gainesville, FL 32608-3813 - Phone
- (352) 376-8821
- Fax
- (352) 382-7781
- NPI assigned
- Apr 25, 2018
- Last updated
- Apr 25, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 | PT31978 | FL | Primary |
Addresses
Primary practice location
4842 SW Archer Rd
Gainesville, FL 32608-3813
Mailing address
16686 NW 194TH Ter
High Springs, FL 32643-8182
Phone (352) 382-7214
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT31978 | FL | MD | Physical Therapist |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524614400000",
"number": "1699263616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16686 NW 194TH TER",
"city": "HIGH SPRINGS",
"state": "FL",
"postal_code": "326438182",
"telephone_number": "352-382-7214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4842 SW ARCHER RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326083813",
"telephone_number": "352-376-8821",
"fax_number": "352-382-7781"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGEN",
"first_name": "MOLLY",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-25",
"last_updated": "2018-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT31978",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.