Provider Demographics
NPI:1558595942
Name:HAGLEY, DENISE R (MPT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:R
Last Name:HAGLEY
Suffix:
Gender:F
Credentials:MPT
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 1549
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20717-1549
Mailing Address - Country:US
Mailing Address - Phone:301-928-9212
Mailing Address - Fax:
Practice Address - Street 1:9500 ANNAPOLIS RD
Practice Address - Street 2:SUITE C4
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2060
Practice Address - Country:US
Practice Address - Phone:301-577-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist