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General NPI Number Information
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NPI Number | 1740243468
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Entity Type | Individual
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Provider Name | CHRISTOPHER MATHEW HAGEMANN ATC
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Gender | Male
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Dates
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Enumeration Date | 04/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2095 HILLSIDE RD UNIT 3078
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City | STORRS
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State | CT
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Zip | 06269-9017
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Country | US
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Telephone | 860-486-6353
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Fax |
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Provider Business Mailing Address
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Address Line | 609 MERROW RD APT 4
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City | TOLLAND
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State | CT
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Zip | 06084-3964
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Country | US
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Telephone | 315-489-1873
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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