Provider Demographics
NPI:1801338611
Name:HAUGER, EVAN CHARLES (DPT, CSCS)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:CHARLES
Last Name:HAUGER
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4990 HILLSDALE CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5770
Mailing Address - Country:US
Mailing Address - Phone:916-905-6378
Mailing Address - Fax:
Practice Address - Street 1:4990 HILLSDALE CIR STE 100
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-5770
Practice Address - Country:US
Practice Address - Phone:916-905-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2924312251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports