Basic Information
| Provider Information | |||||||||
| NPI: | 1831795392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAGAN | ||||||||
| FirstName: | SASHAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21327 PINE ST | ||||||||
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| City: | CORNELIUS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280316524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732223116 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10926 DAVID TAYLOR DR STE 120 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282620039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668396979 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2020 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.