Individual
BENJAMIN G HAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
9331 PHOENIX VILLAGE PKWY, O FALLON, MO 63368-4281
(636) 561-4793
(636) 561-4811
Mailing address
2454 W CLAY ST, SAINT CHARLES, MO 63301-2548
(636) 916-4625
(636) 916-4628
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2011014886
MO
Other
Enumeration date
06/01/2011
Last updated
06/01/2011
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