Provider Demographics
NPI:1013647361
Name:HAAG, ELIJAH (PT)
Entity Type:Individual
Prefix:
First Name:ELIJAH
Middle Name:
Last Name:HAAG
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 1:8505 MIDLOTHIAN TPKE STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5123
Mailing Address - Country:US
Mailing Address - Phone:804-330-3860
Mailing Address - Fax:
Practice Address - Street 1:8505 MIDLOTHIAN TPKE STE A
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5123
Practice Address - Country:US
Practice Address - Phone:804-330-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist