Provider Demographics
NPI:1376677211
Name:HAGENSICK, LAUREL ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LAUREL
Middle Name:ANN
Last Name:HAGENSICK
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 1:202 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:MC GREGOR
Mailing Address - State:IA
Mailing Address - Zip Code:52157-8515
Mailing Address - Country:US
Mailing Address - Phone:563-873-2542
Mailing Address - Fax:
Practice Address - Street 1:40 1ST ST SE
Practice Address - Street 2:
Practice Address - City:WAUKON
Practice Address - State:IA
Practice Address - Zip Code:52172-2022
Practice Address - Country:US
Practice Address - Phone:563-568-3411
Practice Address - Fax:563-568-5699
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist