Provider Demographics
NPI:1629844360
Name:HAGER, BRIANA NICHOLLE (PTA)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:NICHOLLE
Last Name:HAGER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 OLENTANGY RIVER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3425
Mailing Address - Country:US
Mailing Address - Phone:614-407-8645
Mailing Address - Fax:
Practice Address - Street 1:3773 OLENTANGY RIVER RD STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3425
Practice Address - Country:US
Practice Address - Phone:614-407-8645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA013659208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation