Provider Demographics
NPI:1679042337
Name:HAGGARTY, ANNA PAULA (PT)
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:PAULA
Last Name:HAGGARTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANNA PAULA
Other - Middle Name:AVILA
Other - Last Name:BONIFACIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12413 JUDSON RD STE 260
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3262
Mailing Address - Country:US
Mailing Address - Phone:210-656-7953
Mailing Address - Fax:
Practice Address - Street 1:1415 E WALNUT ST STE 500
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5181
Practice Address - Country:US
Practice Address - Phone:830-240-2608
Practice Address - Fax:830-240-2609
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-24
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1264272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist