Provider Demographics
NPI:1013958289
Name:HAAS, SHANE EDWARD (PT)
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:EDWARD
Last Name:HAAS
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 1:5606 GENEVA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-4824
Mailing Address - Country:US
Mailing Address - Phone:806-797-3805
Mailing Address - Fax:806-797-0140
Practice Address - Street 1:5606 GENEVA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-4824
Practice Address - Country:US
Practice Address - Phone:806-797-3805
Practice Address - Fax:806-797-0140
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1119246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611149Medicare ID - Type Unspecified