Provider Demographics
NPI:1205122819
Name:HAUCK, RALPH RICHARD (PTA)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:RICHARD
Last Name:HAUCK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 HOLLY ROSS LN
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-7767
Mailing Address - Country:US
Mailing Address - Phone:770-500-2929
Mailing Address - Fax:
Practice Address - Street 1:819 HOLLY ROSS LN
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31503-7767
Practice Address - Country:US
Practice Address - Phone:770-500-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAA000841225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant