Provider Demographics
NPI:1861472771
Name:HAGAMAN, PAMELA F (PT,OCS)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:F
Last Name:HAGAMAN
Suffix:
Gender:F
Credentials:PT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 STATE FARM RD
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5077
Mailing Address - Country:US
Mailing Address - Phone:828-263-8344
Mailing Address - Fax:828-263-8346
Practice Address - Street 1:950 STATE FARM RD
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5021
Practice Address - Country:US
Practice Address - Phone:828-263-8344
Practice Address - Fax:828-263-8346
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5033225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07832OtherBCBS
NCD7811OtherMED-COST
NCD7811OtherMED-COST