| Doctor Name: | PAUL FAGERSTROM |
| NPI Number: | 1558572735 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT |
| License Number: | J1-0001848 |
| Business Practice Address: | 1403 Shirley Ln Perkasie, PA - 189442868 |
| Business Phone Number: | 2154530615 |
| Business Fax Number: | 2154532076 |
| Mailing Address: | 16 Sheffield Ln, MOUNT LAUREL |
| State: | NJ |
| Postal Code: | 080543318 |
| Phone Number: | 8567220878 |
| Fax Number: | 8563801365 |
| NPI Enumeration Date: | 05/27/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | J1-0001848 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | DE |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |