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General NPI Number Information
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NPI Number | 1194712372
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Entity Type | Individual
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Provider Name | ELEANOR MARGARET HAGAN PT, MPT
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Gender | Female
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 2 JENNY LYNN DR
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1532
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Country | US
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Telephone | 609-412-4449
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Fax | 609-645-9459
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Provider Business Mailing Address
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Address Line | 2 JENNY LYNN DR
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City | NORTHFIELD
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State | NJ
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Zip | 08225-1532
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Country | US
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Telephone | 609-645-5058
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Fax | 609-645-9459
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA00915700
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License Number State | NJ
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