Provider Demographics
NPI:1851933790
Name:HAGER, BRYN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRYN
Middle Name:
Last Name:HAGER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4573 RIVER PKWY APT J
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3875
Mailing Address - Country:US
Mailing Address - Phone:920-606-6169
Mailing Address - Fax:
Practice Address - Street 1:3100 NORTHSIDE PKWY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-1563
Practice Address - Country:US
Practice Address - Phone:920-606-6169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist