# CAPACITY PERFORMANCE THERAPY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497385215
- **Authorized official:** MR. NICHOLAS DONALD HAGEN PT (DIRECTOR CAPACITY PERFORMANCE THERA)
- **Authorized official phone:** (541) 224-7485

## Contact information

- **Practice address:** 61125 LODGEPOLE DR., BEND, OR 97702
- **Practice address phone:** (541) 224-7485
- **Mailing address:** 61125 LODGEPOLE DR., BEND, OR 97702
- **Mailing address phone:** (541) 224-7485

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081S0010X | Sports Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |

## Other

- **Enumeration date:** 01/21/2020
- **Last updated:** 01/21/2020