Provider Demographics
NPI:1568507358
Name:HAGGARD, ERIC ALEXANDER (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:ALEXANDER
Last Name:HAGGARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 S WILLARD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6744
Mailing Address - Country:US
Mailing Address - Phone:928-284-0166
Mailing Address - Fax:928-284-1810
Practice Address - Street 1:450 S WILLARD ST STE 101
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6744
Practice Address - Country:US
Practice Address - Phone:928-284-0166
Practice Address - Fax:928-284-1810
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ751306Medicaid
AZAZ0461410OtherBCBS
AZP54314Medicare UPIN
AZAZ0461410OtherBCBS