Individual
TARA E BAGNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
742 STERBENZ DR, HUDSON, WI 54016-8327
(715) 386-2128
Mailing address
8077 155TH LN NW, RAMSEY, MN 55303-3888
(715) 821-0684
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
5501015984
MI
Other
Enumeration date
09/17/2012
Last updated
11/26/2019
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