Provider Demographics
NPI:1245769306
Name:HAACK, RIO
Entity Type:Individual
Prefix:
First Name:RIO
Middle Name:
Last Name:HAACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 BROADWAY AVE N
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-4594
Mailing Address - Country:US
Mailing Address - Phone:507-259-7570
Mailing Address - Fax:
Practice Address - Street 1:2530 BROADWAY AVE N
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-4594
Practice Address - Country:US
Practice Address - Phone:507-259-7570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist