Individual
EVAN MIKEL HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, PTA
Contact information
Practice address
2610 GREENLAWN ST SE, LACEY, WA 98503-3736
(360) 701-4573
Mailing address
2610 GREENLAWN ST SE, LACEY, WA 98503-3736
(360) 701-4573
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
P1 60167096
WA
2255A2300X
Athletic Trainer
A1 60030239
WA
Other
Enumeration date
10/10/2012
Last updated
10/10/2012
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