Organization
CAPACITY PERFORMANCE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICHOLAS DONALD HAGEN PT (DIRECTOR CAPACITY PERFORMANCE THERA)
(541) 224-7485
Entity
Organization
Contact information
Practice address
61125 LODGEPOLE DR., BEND, OR 97702
(541) 224-7485
Mailing address
61125 LODGEPOLE DR., BEND, OR 97702
(541) 224-7485
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
—
Other
Enumeration date
01/21/2020
Last updated
01/21/2020
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