Provider Demographics
NPI:1932694775
Name:HAGLER, CHRISTINE RAE (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:RAE
Last Name:HAGLER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E DOWNINGTON AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2257
Mailing Address - Country:US
Mailing Address - Phone:208-240-3604
Mailing Address - Fax:
Practice Address - Street 1:306 E DOWNINGTON AVE APT 4
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2257
Practice Address - Country:US
Practice Address - Phone:208-240-3604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9685549-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist