Provider Demographics
NPI:1588455042
Name:HAGEMANN, AUSTIN LEE I (LPTA)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:LEE
Last Name:HAGEMANN
Suffix:I
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N FINDLAY RD
Mailing Address - Street 2:
Mailing Address - City:HASKINS
Mailing Address - State:OH
Mailing Address - Zip Code:43525-9711
Mailing Address - Country:US
Mailing Address - Phone:419-806-2761
Mailing Address - Fax:
Practice Address - Street 1:9640 SYLVANIA METAMORA RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9485
Practice Address - Country:US
Practice Address - Phone:419-724-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA014018225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant