Provider Demographics
NPI:1225144116
Name:HAAS, DAVID YOUNG (MPT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:YOUNG
Last Name:HAAS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 KIMBALL AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6840
Mailing Address - Country:US
Mailing Address - Phone:802-497-0690
Mailing Address - Fax:802-497-0923
Practice Address - Street 1:20 KIMBALL AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6840
Practice Address - Country:US
Practice Address - Phone:802-497-0690
Practice Address - Fax:802-497-0923
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-00036082251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010881Medicaid