Provider Demographics
NPI:1053836718
Name:HAVEN, EMILY ANNE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ANNE
Last Name:HAVEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9351 VERVAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3571
Mailing Address - Country:US
Mailing Address - Phone:858-254-4361
Mailing Address - Fax:
Practice Address - Street 1:9351 VERVAIN STREET
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129
Practice Address - Country:US
Practice Address - Phone:858-254-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist