Provider Demographics
NPI:1114186004
Name:HAGEN, KATHLEEN DEE (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DEE
Last Name:HAGEN
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 1:16455 E. AVENUE OF THE FOUNTAINS
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268
Mailing Address - Country:US
Mailing Address - Phone:480-816-5805
Mailing Address - Fax:480-816-5807
Practice Address - Street 1:16455 E. AVENUE OF THE FOUNTAINS
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268
Practice Address - Country:US
Practice Address - Phone:480-816-5805
Practice Address - Fax:801-495-5303
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist