Provider Demographics
NPI:1467866798
Name:HAUG, KATHRYN MARIE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:HAUG
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 1:3605 TANGLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2415
Mailing Address - Country:US
Mailing Address - Phone:612-483-9422
Mailing Address - Fax:
Practice Address - Street 1:3605 TANGLEWOOD CT
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-2415
Practice Address - Country:US
Practice Address - Phone:612-483-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-14
Last Update Date:2014-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4896225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist