Provider Demographics
NPI:1356300495
Name:HAIG, BRYAN K (PT)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:K
Last Name:HAIG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 PRINCETON PIKE
Mailing Address - Street 2:BLDG. 1-A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2201
Mailing Address - Country:US
Mailing Address - Phone:609-912-0440
Mailing Address - Fax:609-912-1908
Practice Address - Street 1:3131 PRINCETON PIKE
Practice Address - Street 2:BLDG. 1-A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2201
Practice Address - Country:US
Practice Address - Phone:609-912-0440
Practice Address - Fax:609-912-1908
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA00992400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ057081R28Medicare ID - Type Unspecified