Healthcare Provider Details

I. General information

NPI: 1255318226
Provider Name (Legal Business Name): AMIE C HOAGLAND P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 SHERIDAN RD
RACINE WI
53403-4142
US

IV. Provider business mailing address

N72W16078 GOOD HOPE RD
MENOMONEE FALLS WI
53051-4552
US

V. Phone/Fax

Practice location:
  • Phone: 262-554-6515
  • Fax: 262-554-6892
Mailing address:
  • Phone: 262-502-1844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9743-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: