Individual
CHARLEIGH BAGGETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4801 TROUP HWY, SUITE 800, TYLER, TX 75703-2356
(903) 939-2800
Mailing address
5348 OLD JACKSONVILLE HWY, APT 314, TYLER, TX 75703-3350
(817) 433-0721
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2075100
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149984001
—
TX
Enumeration date
07/27/2010
Last updated
07/27/2010
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