Individual
KELLI L HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
8550 MARSHALL DR, STE 100, LENEXA, KS 66214-1505
(913) 894-1500
(913) 647-0295
Mailing address
8550 MARSHALL DR, STE 100, LENEXA, KS 66214-1505
(913) 894-1500
(913) 647-0295
Taxonomy
Speciality
Code
Description
License number
State
2251N0400X
Neurology Physical Therapist
Primary
11-03982
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42826014
BLUECROSS BLUE SHEILD KC
—
01
—
P00975021
MEDICARE RAILROAD
—
Enumeration date
06/25/2009
Last updated
04/26/2016
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