Provider Demographics
NPI:1629790175
Name:LAGEMANN, ADDISON PAIGE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ADDISON
Middle Name:PAIGE
Last Name:LAGEMANN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ADDI
Other - Middle Name:PAIGE
Other - Last Name:LAGEMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:8 WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:BEARDSTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62618-8012
Mailing Address - Country:US
Mailing Address - Phone:217-320-9939
Mailing Address - Fax:
Practice Address - Street 1:8 WALKER AVE
Practice Address - Street 2:
Practice Address - City:BEARDSTOWN
Practice Address - State:IL
Practice Address - Zip Code:62618-8012
Practice Address - Country:US
Practice Address - Phone:217-320-9939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID070024965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist