1609382522 NPI number — MOLLY ANN HAGEMEIER PHYSICAL THERAPIST

Table of content: MOLLY ANN HAGEMEIER PHYSICAL THERAPIST (NPI 1609382522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609382522 NPI number — MOLLY ANN HAGEMEIER PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGEMEIER
Provider First Name:
MOLLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBISON
Provider Other First Name:
MOLLY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609382522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 191
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-928-6464
Provider Business Mailing Address Fax Number:
423-232-7970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2114 E FAIRVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-928-6464
Provider Business Practice Location Address Fax Number:
423-232-7970
Provider Enumeration Date:
12/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  9127 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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