Provider Demographics
NPI:1760042576
Name:HAGGE-COCKE, SIDNEY L (DPT)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:L
Last Name:HAGGE-COCKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SIDNEY
Other - Middle Name:
Other - Last Name:HAGGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:200 W DOUGLAS AVE STE 1040
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3017
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:
Practice Address - Street 1:8550 MARSHALL DR STE 210
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-9836
Practice Address - Country:US
Practice Address - Phone:913-492-0333
Practice Address - Fax:913-492-0334
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1106119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist