Provider Demographics
NPI:1740243468
Name:HAGEMANN, CHRISTOPHER MATHEW (ATC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MATHEW
Last Name:HAGEMANN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 MERROW RD
Mailing Address - Street 2:APT 4
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3964
Mailing Address - Country:US
Mailing Address - Phone:315-489-1873
Mailing Address - Fax:
Practice Address - Street 1:2095 HILLSIDE RD
Practice Address - Street 2:UNIT 3078
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-9017
Practice Address - Country:US
Practice Address - Phone:860-486-6353
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer