Provider Demographics
NPI:1811999527
Name:HAGGERTY, DANIELLE MARIE (PT)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MARIE
Last Name:HAGGERTY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:FOLSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:881 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468-5918
Mailing Address - Country:US
Mailing Address - Phone:207-852-2150
Mailing Address - Fax:866-220-5031
Practice Address - Street 1:840 HAMMOND ST STE 2
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4339
Practice Address - Country:US
Practice Address - Phone:207-433-7778
Practice Address - Fax:866-220-5031
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00304281OtherRAILROAD MEDICARE
ME100550OtherBLUE CROSS & BLUE SHIELD
MEPT2083OtherPT LICENSE
MEUX9791Medicare PIN
MEPT2083OtherPT LICENSE