Individual
MRS. FAITH HAGERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
17817
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3348488
AETNA HEALTH CARE
MD
01
—
497754
MAMSI
MD
01
—
54883608
CAREFIRST BLUE SHIELD
MD
01
—
S4410005
CAREFIRST BLUE CHOICE
MD
Enumeration date
11/13/2006
Last updated
09/16/2011
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