Provider Demographics
NPI:1336484179
Name:HAGER, JAMES ARNOLD (PTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ARNOLD
Last Name:HAGER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 RHINE STRASSE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9110
Mailing Address - Country:US
Mailing Address - Phone:812-661-0902
Mailing Address - Fax:
Practice Address - Street 1:4614 RHINE STRASSE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9110
Practice Address - Country:US
Practice Address - Phone:812-661-0902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA0757225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant