Individual
KYLE HAGERICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 17TH ST, STANTON, NE 68779-2302
(402) 439-2111
Mailing address
25177 SW PARKWAY AVE, STE D, WILSONVILLE, OR 97070
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA011513
OH
Other
Enumeration date
01/19/2018
Last updated
01/19/2018
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