Healthcare Provider Details

I. General information

NPI: 1164767521
Provider Name (Legal Business Name): RIMA HAGGERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7320 SW HUNZIKER ST SUITE 203
TIGARD OR
97223-8283
US

IV. Provider business mailing address

7320 SW HUNZIKER ST SUITE 203
TIGARD OR
97223-8283
US

V. Phone/Fax

Practice location:
  • Phone: 888-317-1019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number08887
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number9632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: