Provider Demographics
NPI:1831420736
Name:HAGAN, DEEANNA (RMT)
Entity type:Individual
Prefix:MRS
First Name:DEEANNA
Middle Name:
Last Name:HAGAN
Suffix:
Gender:F
Credentials:RMT
Other - Prefix:
Other - First Name:DEEANNA
Other - Middle Name:
Other - Last Name:STRIBLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:730 W HAMPDEN AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2120
Mailing Address - Country:US
Mailing Address - Phone:303-758-6400
Mailing Address - Fax:303-759-1276
Practice Address - Street 1:730 W HAMPDEN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2120
Practice Address - Country:US
Practice Address - Phone:303-758-6400
Practice Address - Fax:303-759-1276
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1454225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist