Provider Demographics
NPI:1568955326
Name:HAGGERMAKER, CARLY (PT, DPT)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:HAGGERMAKER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:7500 RIALTO BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8531
Mailing Address - Country:US
Mailing Address - Phone:737-284-2450
Mailing Address - Fax:
Practice Address - Street 1:7500 RIALTO BLVD STE 230
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8531
Practice Address - Country:US
Practice Address - Phone:737-284-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist