Individual
NICHOLAS D HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, SCS, CSCS
Contact information
Practice address
1160 SW SIMPSON AVE, STE 200, BEND, OR 97702
(541) 322-9045
(541) 322-9044
Mailing address
805 SW INDUSTRIAL WAY, STE 3, BEND, OR 97702-1093
(541) 585-2529
(541) 585-2536
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
6856
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500695874
—
OR
Enumeration date
12/07/2009
Last updated
03/03/2016
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