Provider Demographics
NPI:1083852776
Name:HAGEN, LINDSEY E (PT)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:E
Last Name:HAGEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:E
Other - Last Name:FITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:805 SW INDUSTRIAL WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1093
Mailing Address - Country:US
Mailing Address - Phone:541-585-2529
Mailing Address - Fax:541-585-2536
Practice Address - Street 1:1303 NE CUSHING DR
Practice Address - Street 2:SUITE 150
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3891
Practice Address - Country:US
Practice Address - Phone:541-382-7875
Practice Address - Fax:541-382-2181
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06855225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500649316Medicaid
OR500649316Medicaid