Provider Demographics
NPI:1982034880
Name:HAGA, KIMBERLY A (LMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:HAGA
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-5590
Mailing Address - Fax:717-851-5957
Practice Address - Street 1:140 PINE GROVE COMMONS
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5151
Practice Address - Country:US
Practice Address - Phone:717-851-5590
Practice Address - Fax:717-851-5957
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG007696225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist