Provider Demographics
NPI:1922417542
Name:HAITZ, TIMOTHY
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:HAITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:MICHAEL
Other - Last Name:HAITZ
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:721 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-4430
Mailing Address - Country:US
Mailing Address - Phone:401-946-4250
Mailing Address - Fax:401-275-5645
Practice Address - Street 1:721 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-4430
Practice Address - Country:US
Practice Address - Phone:401-946-4250
Practice Address - Fax:401-275-5645
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI27072251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic