Provider Demographics
NPI:1538487889
Name:BAGGA, RITA T (PT)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:T
Last Name:BAGGA
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 1:9206 WATERSIDE ST
Mailing Address - Street 2:APT # 213
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5090
Mailing Address - Country:US
Mailing Address - Phone:608-721-0000
Mailing Address - Fax:
Practice Address - Street 1:9206 WATERSIDE ST
Practice Address - Street 2:APARTMENT # 213
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5090
Practice Address - Country:US
Practice Address - Phone:608-721-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11185-024172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA15921OtherPHYSICAL THERAPY MA LICENSE
WI11185-024OtherPHYSICAL THERAPY LICENSE