Provider Demographics
NPI:1629283916
Name:HAGGERTY, JULIE DIANE (PT DPT, PCS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:DIANE
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:PT DPT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58D RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-4283
Mailing Address - Country:US
Mailing Address - Phone:973-401-1799
Mailing Address - Fax:
Practice Address - Street 1:15 HALKO DR
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1306
Practice Address - Country:US
Practice Address - Phone:973-829-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA009504002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics