Provider Demographics
NPI:1063734408
Name:FEATHERSTON HAGAR, TANDY N (PT)
Entity type:Individual
Prefix:
First Name:TANDY
Middle Name:N
Last Name:FEATHERSTON HAGAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 BILL BRADFORD
Mailing Address - Street 2:STE 101
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-4538
Mailing Address - Country:US
Mailing Address - Phone:903-885-5919
Mailing Address - Fax:
Practice Address - Street 1:614 BILL BRADFORD
Practice Address - Street 2:STE 101
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-4538
Practice Address - Country:US
Practice Address - Phone:903-885-5919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1158950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1158950OtherPT OT BOARD