Healthcare Provider Details

I. General information

NPI: 1922503010
Provider Name (Legal Business Name): DAVID JAMES HAGERTY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9437 OLIVE BLVD
OLIVETTE MO
63132-3130
US

IV. Provider business mailing address

1464 SUMMERPOINT LN
FENTON MO
63026-6958
US

V. Phone/Fax

Practice location:
  • Phone: 314-989-9500
  • Fax: 314-989-9995
Mailing address:
  • Phone: 563-260-3832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number298435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: