Provider Demographics
NPI:1104095140
Name:HAASE, ALLISON MARIE
Entity type:Individual
Prefix:MISS
First Name:ALLISON
Middle Name:MARIE
Last Name:HAASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 RIBAUT RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5476
Mailing Address - Country:US
Mailing Address - Phone:843-706-9940
Mailing Address - Fax:
Practice Address - Street 1:1076 RIBAUT RD
Practice Address - Street 2:SUITE 10
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5476
Practice Address - Country:US
Practice Address - Phone:843-706-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2112225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant