| NPI | 1710157409 |
|---|---|
| Former Name | THERESA RENE HAGGERTY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2013018903) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1101756) |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2019-11-26 |