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NPI Code Detail

MEDICARE: HENRY CHARLES HAGOOD DPT

MEDICARE: HENRY CHARLES HAGOOD 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 TherapistPTP-PT-LIC-24309MT

General Provider Information

NPI Number : 1578276671
Entity Type Code : Individual
Provider Name (Legal Business Name) : HENRY CHARLES HAGOOD DPT
Provider Business Mailing Address
First Line : 3315 WASHBURN ST
Second Line :
City : MISSOULA
State : MT
Zip : 59801-8432
Country : US
Telephone Number : 509-362-2838
Fax Number :
Provider Business Practice Location Address
First Line : 1301 E BROADWAY ST
Second Line :
City : MISSOULA
State : MT
Zip : 59802-4905
Country : US
Telephone Number : 406-721-0680
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2023
Last Update Date : 01/04/2023

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