Provider Demographics
NPI:1184434375
Name:HAAG, PAUL J (LMT (LICENSED MASSAG)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:HAAG
Suffix:
Gender:M
Credentials:LMT (LICENSED MASSAG
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 404
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:AK
Mailing Address - Zip Code:99833
Mailing Address - Country:US
Mailing Address - Phone:512-434-0943
Mailing Address - Fax:
Practice Address - Street 1:401 HAUSEN DR #103
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:AK
Practice Address - Zip Code:99833
Practice Address - Country:US
Practice Address - Phone:907-772-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK145177225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist