Healthcare Provider Details

I. General information

NPI: 1629844360
Provider Name (Legal Business Name): BRIANA NICHOLLE HAGER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3773 OLENTANGY RIVER RD STE 201
COLUMBUS OH
43214-3425
US

IV. Provider business mailing address

3773 OLENTANGY RIVER RD STE 201
COLUMBUS OH
43214-3425
US

V. Phone/Fax

Practice location:
  • Phone: 614-407-8645
  • Fax:
Mailing address:
  • Phone: 614-407-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPTA013659
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: