Provider Demographics
NPI:1063652683
Name:HAAS, JONELLE (PTA)
Entity Type:Individual
Prefix:
First Name:JONELLE
Middle Name:
Last Name:HAAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24282 EASTWOOD VILLAGE DR
Mailing Address - Street 2:# 205
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-5809
Mailing Address - Country:US
Mailing Address - Phone:913-579-1412
Mailing Address - Fax:
Practice Address - Street 1:24282 EASTWOOD VILLAGE DR
Practice Address - Street 2:# 205
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-5809
Practice Address - Country:US
Practice Address - Phone:913-579-1412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-22
Last Update Date:2009-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant