Provider Demographics
NPI:1679624795
Name:HAUSCHKA, EDWARD O
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:O
Last Name:HAUSCHKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7840
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-7840
Mailing Address - Country:US
Mailing Address - Phone:949-443-5442
Mailing Address - Fax:949-443-5463
Practice Address - Street 1:31341 NIGUEL RD STE G
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-4118
Practice Address - Country:US
Practice Address - Phone:949-443-5442
Practice Address - Fax:949-443-5463
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist