Provider Demographics
NPI:1376876938
Name:HAGGSTROM, INGRID NORMA (PT)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:NORMA
Last Name:HAGGSTROM
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 1:1411 WEST COUNTY LINE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142
Mailing Address - Country:US
Mailing Address - Phone:800-486-4449
Mailing Address - Fax:317-886-5027
Practice Address - Street 1:1411 WEST COUNTY LINE RD,
Practice Address - Street 2:SUITE A. HTS OUTPATIENT THERAPY SERVICES
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142
Practice Address - Country:US
Practice Address - Phone:800-486-4449
Practice Address - Fax:317-886-5027
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004420A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist