Provider Demographics
NPI:1538569660
Name:HAGERTY, THOMAS PATRICK
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:PATRICK
Last Name:HAGERTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26395 SAINT CROIX TRL
Mailing Address - Street 2:
Mailing Address - City:SHAFER
Mailing Address - State:MN
Mailing Address - Zip Code:55074-9643
Mailing Address - Country:US
Mailing Address - Phone:651-257-5900
Mailing Address - Fax:
Practice Address - Street 1:26395 SAINT CROIX TRL
Practice Address - Street 2:
Practice Address - City:SHAFER
Practice Address - State:MN
Practice Address - Zip Code:55074-9643
Practice Address - Country:US
Practice Address - Phone:651-257-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist