Provider Demographics
NPI:1780797266
Name:HABER, JOSEPH VICTA (PT)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:VICTA
Last Name:HABER
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 1:8194 N PORT
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8062
Mailing Address - Country:US
Mailing Address - Phone:810-820-0235
Mailing Address - Fax:
Practice Address - Street 1:8194 N PORT
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8062
Practice Address - Country:US
Practice Address - Phone:810-820-0235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007276225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M93100Medicare ID - Type UnspecifiedPHYSICAL THERAPY PROVIDER