Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT3697 | WA |
N | 2251G0304X | Physical Therapist - Geriatrics | PT3697 | WA |
N | 2251N0400X | Physical Therapist - Neurology | ||
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1740280254 |
---|---|
Provider Name | James K Haberstro |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Gig Harbor, WA 98335-1851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 07/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8333296 | (05) | WA |