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1225151970
DARYL FAGAN
DALTON, GA
NPI
1225151970
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: GA PTA 001546)
Enumeration Date
2007-04-09
Last Update Date
2007-07-08
Business Address
Mr. DARYL FAGAN
1225 BROADRICK DR
DALTON, GA 30720-2504
Phone number: 706-272-6199
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Mailing Address
Mr. DARYL FAGAN
45 BOXER LN
ROCK SPRING, GA 30739-8016
Phone number:
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