Provider Demographics
NPI:1235229451
Name:HAGGERTON, PATRICIA ANN (PT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:HAGGERTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:8 MOGOLLON TRAIL
Mailing Address - City:HIGH ROLLS MOUNTAIN PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88325-0314
Mailing Address - Country:US
Mailing Address - Phone:505-682-2476
Mailing Address - Fax:
Practice Address - Street 1:1011 10TH ST # A
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6425
Practice Address - Country:US
Practice Address - Phone:505-439-9878
Practice Address - Fax:505-439-9876
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist