Provider Demographics
NPI:1528431384
Name:HAAS, BRIAN PATRICK (PT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PATRICK
Last Name:HAAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 NORTHWAY ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-8406
Mailing Address - Country:US
Mailing Address - Phone:570-419-1155
Mailing Address - Fax:
Practice Address - Street 1:1143 NORTHWAY ROAD EXT
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-8406
Practice Address - Country:US
Practice Address - Phone:570-419-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006795L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist