Provider Demographics
NPI:1083699888
Name:HAGEE, DONIEL M (DPT)
Entity Type:Individual
Prefix:DR
First Name:DONIEL
Middle Name:M
Last Name:HAGEE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:DONIEL
Other - Middle Name:M
Other - Last Name:CHAUVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8862 BENDER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-8800
Mailing Address - Country:US
Mailing Address - Phone:360-354-1115
Mailing Address - Fax:360-354-0321
Practice Address - Street 1:8862 BENDER RD STE 101
Practice Address - Street 2:
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-8800
Practice Address - Country:US
Practice Address - Phone:360-354-1115
Practice Address - Fax:360-354-0321
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009898225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8910750OtherCAPSTONE PT MEDICARE PTAN
WAPT00009898OtherSTATE OF WA PT LICENSE