Active NPI
Kyle Hagerich
- Physical Therapy Assistant
- Stanton, NE
National Provider Identifier
1700394194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA011513
- Practice address
- 301 17TH St
Stanton, NE 68779-2302 - Phone
- (402) 439-2111
- NPI assigned
- Jan 19, 2018
- Last updated
- Jan 19, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA011513 | OH | Primary |
Addresses
Primary practice location
301 17TH St
Stanton, NE 68779-2302
Mailing address
25177 SW Parkway Ave
Ste D
Wilsonville, OR 97070
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA011513 | OH | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516320000000",
"number": "1700394194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25177 SW PARKWAY AVE",
"address_2": "STE D",
"city": "WILSONVILLE",
"state": "OR",
"postal_code": "97070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 17TH ST",
"city": "STANTON",
"state": "NE",
"postal_code": "687792302",
"telephone_number": "402-439-2111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGERICH",
"first_name": "KYLE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-01-19",
"last_updated": "2018-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OH",
"license": "PTA011513",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stanton, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.