Provider Demographics
NPI:1124568522
Name:HAGGERTY, LAURIE
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PATCH POND RD UNIT 34
Mailing Address - Street 2:
Mailing Address - City:CENTER OSSIPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03814-6128
Mailing Address - Country:US
Mailing Address - Phone:978-500-0014
Mailing Address - Fax:
Practice Address - Street 1:50 PATCH POND RD UNIT 34
Practice Address - Street 2:
Practice Address - City:CENTER OSSIPEE
Practice Address - State:NH
Practice Address - Zip Code:03814-6128
Practice Address - Country:US
Practice Address - Phone:978-500-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist