Provider Demographics
NPI:1598168403
Name:HAGUEWOOD, VICKIE (PTA)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:
Last Name:HAGUEWOOD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8172 RAVENHILL DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2408
Mailing Address - Country:US
Mailing Address - Phone:901-361-3233
Mailing Address - Fax:
Practice Address - Street 1:8172 RAVENHILL DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2408
Practice Address - Country:US
Practice Address - Phone:901-361-3233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5818225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant