Provider Demographics
NPI:1003892258
Name:HAGER, KRISTIE L (CPTA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:L
Last Name:HAGER
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 POPE AVE
Mailing Address - Street 2:MUNSON ARMY HEALTH CENTER ATTN: MXCN-COD, MS. COTTON
Mailing Address - City:FORT LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66027-2333
Mailing Address - Country:US
Mailing Address - Phone:913-684-6562
Mailing Address - Fax:913-684-6208
Practice Address - Street 1:505 POPE AVE
Practice Address - Street 2:MUNSON ARMY HEALTH CENTER ATTN: MXCN-COD, MS. COTTON
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-2333
Practice Address - Country:US
Practice Address - Phone:913-684-6562
Practice Address - Fax:913-684-6208
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-00966225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant