Provider Demographics
NPI:1538403159
Name:HOAGLAND, CURTIS M (MPT)
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:M
Last Name:HOAGLAND
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3483 S KENTUCKY WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6997
Mailing Address - Country:US
Mailing Address - Phone:208-401-4546
Mailing Address - Fax:
Practice Address - Street 1:3483 S KENTUCKY WAY
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6997
Practice Address - Country:US
Practice Address - Phone:208-401-4546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-3021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist