Provider Demographics
NPI:1114233061
Name:HAGER, DEAN RALPH (LMT)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:RALPH
Last Name:HAGER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 US 1 STE 5
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5703
Mailing Address - Country:US
Mailing Address - Phone:772-713-4992
Mailing Address - Fax:
Practice Address - Street 1:1360 US 1 STE 5
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5703
Practice Address - Country:US
Practice Address - Phone:772-713-4992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-28
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-36429225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2278OtherBCBS