Provider Demographics
NPI:1093827743
Name:ELLING, HAAN J (PT)
Entity Type:Individual
Prefix:
First Name:HAAN
Middle Name:J
Last Name:ELLING
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 1:125 N LINCOLN ST STE H
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-3260
Mailing Address - Country:US
Mailing Address - Phone:707-718-0151
Mailing Address - Fax:707-637-8152
Practice Address - Street 1:125 N LINCOLN ST STE H
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620
Practice Address - Country:US
Practice Address - Phone:707-718-0151
Practice Address - Fax:707-637-8152
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT225150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT225150Medicare ID - Type Unspecified