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General NPI Number Information
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NPI Number | 1962145169
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Entity Type | Individual
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Provider Name | CHRISTOPHER WAYNE HAGGER JR.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2022
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Last Update Date | 04/15/2022
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Provider Practice Location Address
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Address Line | 4207 GARDENDALE ST STE 104B
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3142
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Country | US
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Telephone | 817-505-2575
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Fax | 833-214-0911
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Provider Business Mailing Address
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Address Line | 4102 S NEW BRAUNFELS AVE STE 110 PO BOX 121
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City | SAN ANTONIO
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State | TX
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Zip | 78223-1717
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Country | US
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Telephone | 850-426-7848
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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 | 2167840
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License Number State | TX
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