Provider Demographics
NPI:1124083829
Name:HAGLEN, RICHARD HENRY (MSPT, CSCS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:HENRY
Last Name:HAGLEN
Suffix:
Gender:M
Credentials:MSPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2850 COMMERCE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-9383
Mailing Address - Country:US
Mailing Address - Phone:717-541-4348
Mailing Address - Fax:717-541-9576
Practice Address - Street 1:200 LINDELL BLVD
Practice Address - Street 2:SUITE 922
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3265
Practice Address - Country:US
Practice Address - Phone:561-278-6770
Practice Address - Fax:561-278-6771
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015010225100000X
FLPT19964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA049425Medicare PIN
FLU3650ZMedicare PIN