Provider Demographics
NPI:1285032672
Name:HAUGER, RICHARD (PTA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:HAUGER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:LUCAS
Mailing Address - State:OH
Mailing Address - Zip Code:44843-9519
Mailing Address - Country:US
Mailing Address - Phone:419-989-9610
Mailing Address - Fax:
Practice Address - Street 1:3755 WASHINGTON SOUTH RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-9066
Practice Address - Country:US
Practice Address - Phone:419-886-1983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07313225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant