Jade Elise Fagan, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

LPT31072 Issued in AZ

Practice address

11812 N 19TH Ave
Phoenix, AZ 85029-3536

Phone

(602) 833-4177

NPI assigned

Jun 9, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1881989606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8545 MARYS DR",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041211",
            "telephone_number": "214-405-6853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11812 N 19TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850293536",
            "telephone_number": "602-833-4177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "JADE",
        "middle_name": "ELISE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-09",
        "last_updated": "2026-09-29",
        "certification_date": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "CP053760T",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NH",
            "license": "CP051734T",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "CP052658T",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "LPT31072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Abualalaa Mustafa Fadlelmula
• Sami A Fadlelmula, TRANSPORTAITION
• Siobhan Emily Faenza, MD
• Charlotte Moffett Fafard, RN.
• Alyssa L Fagan-Clark, LCSW
• Joseph Michael Fagan, LMSW
• Ibukun Ajoke Fagbuyi, PMHNP
• Sarita Fager, MA, LPC
• Chris David Fagerlie
• Seth Alfred Fagerlie, MD

• Physical Therapist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; 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.