Active NPI
Jade Elise Fagan, PT
- Geriatric Physical Therapist
- Dallas, TX
National Provider Identifier
1881989606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- 1158980
- Practice address
- 3362 Forest LN
Dallas, TX 75234-7796 - Phone
- (972) 488-1300
- Fax
- (972) 488-1301
- NPI assigned
- Jun 9, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | 1158980 | TX | Primary |
Addresses
Primary practice location
3362 Forest LN
Dallas, TX 75234-7796
Mailing address
2936 Esterbrook Dr
Farmers Branch, TX 75234-4937
Phone (217) 405-6853
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 |
|---|---|---|---|
| 1158980 | TX | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307577600000",
"number": "1881989606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2936 ESTERBROOK DR",
"city": "FARMERS BRANCH",
"state": "TX",
"postal_code": "752344937",
"telephone_number": "217-405-6853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3362 FOREST LN",
"city": "DALLAS",
"state": "TX",
"postal_code": "752347796",
"telephone_number": "972-488-1300",
"fax_number": "972-488-1301"
}
],
"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": "2011-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "TX",
"license": "1158980",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.