Provider Demographics
NPI:1760065247
Name:HAGEN MOVEMENT INSTITUTE
Entity Type:Organization
Organization Name:HAGEN MOVEMENT INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-340-7336
Mailing Address - Street 1:1630 SHALLOW CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9605
Mailing Address - Country:US
Mailing Address - Phone:585-340-7336
Mailing Address - Fax:585-397-1947
Practice Address - Street 1:1630 SHALLOW CREEK TRL
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-9605
Practice Address - Country:US
Practice Address - Phone:585-340-7336
Practice Address - Fax:585-397-1947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty