Provider Demographics
NPI:1407150261
Name:O'HAGAN, RILEY NICHOLAS (DPT)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:NICHOLAS
Last Name:O'HAGAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30459
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93130-0459
Mailing Address - Country:US
Mailing Address - Phone:805-898-1907
Mailing Address - Fax:805-687-8121
Practice Address - Street 1:9040 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-2351
Practice Address - Country:US
Practice Address - Phone:805-898-1907
Practice Address - Fax:805-687-8121
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEM361ZMedicare UPIN