Provider Demographics
NPI:1164767521
Name:HAGGERTY, RIMA
Entity Type:Individual
Prefix:
First Name:RIMA
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 1:7320 SW HUNZIKER ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8283
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7320 SW HUNZIKER ST
Practice Address - Street 2:SUITE 203
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8283
Practice Address - Country:US
Practice Address - Phone:888-317-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08887225200000X
CA9632225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant