EVAN MIKEL HAGEN

LACEY, WA
NPI1356693634
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: WA  P1 60167096)
Additional Taxonomies2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: WA  A1 60030239)
Enumeration Date2012-10-10
Last Update Date2012-10-10
Business Address
-- EVAN MIKEL HAGEN ATC, PTA
2610 GREENLAWN ST SE
LACEY, WA 98503-3736
Phone number: 360-701-4573
Mailing Address
-- EVAN MIKEL HAGEN ATC, PTA
2610 GREENLAWN ST SE
LACEY, WA 98503-3736
Phone number: 360-701-4573