Provider Demographics
NPI:1194853176
Name:HAERTIG, PAUL W (LMP)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:W
Last Name:HAERTIG
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20218 77TH AVE NE
Mailing Address - Street 2:STE. A
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223
Mailing Address - Country:US
Mailing Address - Phone:360-435-3900
Mailing Address - Fax:360-435-1105
Practice Address - Street 1:20218 77TH AVE NE
Practice Address - Street 2:STE. A
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223
Practice Address - Country:US
Practice Address - Phone:360-435-3900
Practice Address - Fax:360-435-1105
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00009348225700000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00009348OtherLMP LICENSE #