Most Relevant Information
Provider Data
| NPI Number: | 1003001561 |
| Provider Name: | THERESA ANN HAGMAN PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 86-019 |
Most Important Dates
| Enumeration Date: | 09/07/2007 |
| Last Updated: | 09/07/2007 |
Provider Practice Location
1818 N MEADE ST
APPLETON
WI
549113454
Practice Location Phone/Fax
| Phone: | 9207314101 |
| Fax: |
Provider Mailing Location
PO BOX 2759
APPLETON
WI
549122759
Provider Mailing Phone/Fax
| Phone: | 9208305900 |
| Fax: | 9208305910 |