Provider Demographics
NPI:1003024837
Name:HAGER, AMANDA K (LMT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:K
Last Name:HAGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:SHOALS
Mailing Address - State:WV
Mailing Address - Zip Code:25562-0029
Mailing Address - Country:US
Mailing Address - Phone:304-690-1869
Mailing Address - Fax:
Practice Address - Street 1:611 7TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2113
Practice Address - Country:US
Practice Address - Phone:304-690-1869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2005-1913225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist