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General NPI Number Information
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NPI Number | 1588455042
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Entity Type | Individual
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Provider Name | AUSTIN LEE HAGEMANN I LPTA
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Gender | Male
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Dates
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Enumeration Date | 05/14/2025
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 9640 SYLVANIA METAMORA RD
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City | SYLVANIA
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State | OH
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Zip | 43560-9485
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Country | US
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Telephone | 419-724-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 301 N FINDLAY RD
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City | HASKINS
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State | OH
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Zip | 43525-9711
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Country | US
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Telephone | 419-806-2761
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA014018
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License Number State | OH
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