Basic Information
| Provider Information | |||||||||
| NPI: | 1194237362 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAGOT | ||||||||
| FirstName: | CAITLIN | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 RINGNECK TRL | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173209600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7174792087 | ||||||||
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| Practice Location | |||||||||
| Address1: | 790 W KING ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | LITTLESTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 173401457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173591928 | ||||||||
| FaxNumber: | 7173591929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2017 | ||||||||
| LastUpdateDate: | 11/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | A4826 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | TEI005354 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.