Provider Demographics
NPI:1184891160
Name:HAISLIP, DAVID RICHARD (PTA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RICHARD
Last Name:HAISLIP
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 S 288TH ST TRLR 203
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8006
Mailing Address - Country:US
Mailing Address - Phone:253-946-1260
Mailing Address - Fax:
Practice Address - Street 1:3001 S 288TH ST TRLR 203
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8006
Practice Address - Country:US
Practice Address - Phone:253-946-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant