Provider Demographics
NPI:1194232884
Name:HAGER, BRETT (DPT)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:HAGER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15508 W BELL RD.,
Mailing Address - Street 2:SUITE 101, PMB 210
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:623-432-9965
Mailing Address - Fax:623-243-7646
Practice Address - Street 1:20250 N 75TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-7935
Practice Address - Country:US
Practice Address - Phone:623-432-9965
Practice Address - Fax:623-243-7646
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13556225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ13556OtherSTATE PT LICENSE