Provider Demographics
NPI:1962145169
Name:HAGGER, CHRISTOPHER WAYNE JR
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:WAYNE
Last Name:HAGGER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 S NEW BRAUNFELS AVE STE 110
Mailing Address - Street 2:PO BOX 121
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-1717
Mailing Address - Country:US
Mailing Address - Phone:850-426-7848
Mailing Address - Fax:
Practice Address - Street 1:4207 GARDENDALE ST STE 104B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3142
Practice Address - Country:US
Practice Address - Phone:817-505-2575
Practice Address - Fax:833-214-0911
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2167840225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant