Provider Demographics
NPI:1083691224
Name:HAGER, MICHELLE A (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:A
Last Name:HAGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801W PUTTER
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002
Mailing Address - Country:US
Mailing Address - Phone:701-330-0866
Mailing Address - Fax:
Practice Address - Street 1:7011 W CENTRAL AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3386
Practice Address - Country:US
Practice Address - Phone:316-946-9662
Practice Address - Fax:316-946-9745
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist