Provider Demographics
NPI:1689766347
Name:HAGERMAN, WILLIAM MAURICE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MAURICE
Last Name:HAGERMAN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PRECISION PHYSICAL THERAPY
Mailing Address - Street 2:100 WEST SOUTH STREET
Mailing Address - City:ONTARIO
Mailing Address - State:WI
Mailing Address - Zip Code:54651
Mailing Address - Country:US
Mailing Address - Phone:608-337-4222
Mailing Address - Fax:608-337-4222
Practice Address - Street 1:PRECISION PHYSICAL THERAPY
Practice Address - Street 2:100 WEST SOUTH STREET
Practice Address - City:ONTARIO
Practice Address - State:WI
Practice Address - Zip Code:54651
Practice Address - Country:US
Practice Address - Phone:608-337-4222
Practice Address - Fax:608-337-4222
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4268-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
83021Medicare ID - Type Unspecified