Provider Demographics
NPI:1366593980
Name:HAGEN, DANIEL HENRY (ATC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:HENRY
Last Name:HAGEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 SAINT OLAF AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-1574
Mailing Address - Country:US
Mailing Address - Phone:507-786-3261
Mailing Address - Fax:507-786-3721
Practice Address - Street 1:1520 SAINT OLAF AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-1574
Practice Address - Country:US
Practice Address - Phone:507-786-3261
Practice Address - Fax:507-786-3721
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11912255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer