Provider Demographics
NPI:1154453090
Name:FREEMAN, HABERN WILLIAM (LPT)
Entity Type:Individual
Prefix:
First Name:HABERN
Middle Name:WILLIAM
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 OLD EMMORTON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-8909
Mailing Address - Country:US
Mailing Address - Phone:410-515-1603
Mailing Address - Fax:410-515-1604
Practice Address - Street 1:2208 OLD EMMORTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-8909
Practice Address - Country:US
Practice Address - Phone:410-515-1603
Practice Address - Fax:410-515-1604
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
J224Medicare ID - Type Unspecified