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NPI Code Detail

MEDICARE: REBEKAH ELIZABETH HAGEN DPT

MEDICARE: REBEKAH ELIZABETH HAGEN DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT60022406WA

General Provider Information

NPI Number : 1487819918
Entity Type Code : Individual
Provider Name (Legal Business Name) : REBEKAH ELIZABETH HAGEN DPT
Provider Business Mailing Address
First Line : PO BOX 2170
Second Line :
City : SUMNER
State : WA
Zip : 98390-0480
Country : US
Telephone Number : 253-840-2313
Fax Number : 253-840-6340
Provider Business Practice Location Address
First Line : 19820 SR 410 E
Second Line : STE 201
City : BONNEY LAKE
State : WA
Zip : 98391-6377
Country : US
Telephone Number : 253-863-7510
Fax Number : 253-863-5970
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2008
Last Update Date : 07/24/2008

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Directions to “ REBEKAH ELIZABETH HAGEN DPT” Practice Location

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