1376876938 NPI number — INGRID NORMA HAGGSTROM PT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376876938 NPI number — INGRID NORMA HAGGSTROM PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAGGSTROM
Provider First Name:
INGRID
Provider Middle Name:
NORMA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376876938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1411 WEST COUNTY LINE RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-486-4449
Provider Business Mailing Address Fax Number:
317-886-5027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1411 WEST COUNTY LINE RD,
Provider Second Line Business Practice Location Address:
SUITE A. HTS OUTPATIENT THERAPY SERVICES
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-486-4449
Provider Business Practice Location Address Fax Number:
317-886-5027
Provider Enumeration Date:
09/15/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  05004420A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)