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NPI Code Detail

MEDICARE: DR. LESLIE ERIN HAGERTY DPT

MEDICARE: DR. LESLIE ERIN HAGERTY DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist5501017988MI

General Provider Information

NPI Number : 1396246872
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LESLIE ERIN HAGERTY DPT
Provider Business Mailing Address
First Line : 14231 BEADLE LAKE RD
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49014-8213
Country : US
Telephone Number : 269-704-5180
Fax Number : 269-704-5185
Provider Business Practice Location Address
First Line : 14231 BEADLE LAKE RD
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49014-8213
Country : US
Telephone Number : 269-704-5180
Fax Number : 269-704-5185
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2018
Last Update Date : 09/26/2022

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