Provider Demographics
NPI:1427778711
Name:HAGGARD, DEBORAH (PTA)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:HAGGARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:KELLERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4149 JENSOME LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1163
Mailing Address - Country:US
Mailing Address - Phone:615-631-3196
Mailing Address - Fax:
Practice Address - Street 1:1116 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2310
Practice Address - Country:US
Practice Address - Phone:615-931-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1980225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1980OtherPHYSICAL THERAPIST ASSISTANT LICENSE