Provider Demographics
NPI:1609382522
Name:HAGEMEIER, MOLLY ANN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:HAGEMEIER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANN
Other - Last Name:ROBISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:JOHSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37605
Mailing Address - Country:US
Mailing Address - Phone:423-928-6464
Mailing Address - Fax:423-232-7970
Practice Address - Street 1:2114 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601
Practice Address - Country:US
Practice Address - Phone:423-928-6464
Practice Address - Fax:423-232-7970
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist