Provider Demographics
NPI:1649227257
Name:HAGGART, NANCY RUTLEDGE (PT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:RUTLEDGE
Last Name:HAGGART
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 1:633 SHOREWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-4601
Mailing Address - Country:US
Mailing Address - Phone:218-849-6949
Mailing Address - Fax:
Practice Address - Street 1:633 SHOREWOOD DR
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-4601
Practice Address - Country:US
Practice Address - Phone:218-849-6949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN59D56HAOtherMNBS #
MNDA9031015523OtherPREFERRED ONE #
MN974511OtherAMERICA'S PPO/ARAZ #
MNMN200044OtherLHS/BANNERHEALTH #
MN16145OtherNDBS #
MN6411644OtherMEDICA #
FMHP38653OtherHEALTHPARTNERS #
MN650000343Medicare ID - Type UnspecifiedMN MEDICARE #
MN650018520Medicare ID - Type UnspecifiedRR MEDICARE #