MEDICARE: HEATHER ELIZABETH HAGAN P.T.

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
1	225100000X	Physical Therapist	PT60385021	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01338325	OTHER	WA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780023143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER ELIZABETH HAGAN P.T.

Provider Business Mailing Address
First Line	:	16083 SW UPPER BOONES FERRY RD
Second Line	:	SUITE 300
City	:	TIGARD
State	:	OR
Zip	:	97224-7736
Country	:	US
Telephone Number	:	800-219-8835
Fax Number	:	503-639-9699

Provider Business Practice Location Address
First Line	:	1108 E 1ST ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-4317
Country	:	US
Telephone Number	:	360-452-8216
Fax Number	:	360-452-5765

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	09/03/2014

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