Provider Demographics
NPI:1306154570
Name:HAGER, CAITLYN NICOLE (DPT)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:NICOLE
Last Name:HAGER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:NICOLE
Other - Last Name:ZUNDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1319 EASTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1655 N GRANDVIEW LN
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0877
Practice Address - Country:US
Practice Address - Phone:701-751-2020
Practice Address - Fax:701-223-2207
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 37042225100000X
ND1575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist