MEDICARE: CHRISTINE RAE HAGLER LMT

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
1	225700000X	Massage Therapist	9685549-4701	UT

General Provider Information

NPI Number	:	1932694775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE RAE HAGLER LMT

Provider Business Mailing Address
First Line	:	306 E DOWNINGTON AVE APT 4
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-2257
Country	:	US
Telephone Number	:	208-240-3604
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 E DOWNINGTON AVE APT 4
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115-2257
Country	:	US
Telephone Number	:	208-240-3604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	06/25/2018

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