Provider Demographics
NPI:1558937938
Name:HAASE, CHRISTINE THERESA
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:THERESA
Last Name:HAASE
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 1:501 TOWER DR APT 120
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306-6877
Mailing Address - Country:US
Mailing Address - Phone:518-847-8692
Mailing Address - Fax:
Practice Address - Street 1:2256 BURDETT AVE STE 1
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2498
Practice Address - Country:US
Practice Address - Phone:518-274-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02595261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy