Provider Demographics
NPI:1427865005
Name:HASKINS, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HASKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21215 DETROIT RD APT A106
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2256
Mailing Address - Country:US
Mailing Address - Phone:330-774-3124
Mailing Address - Fax:
Practice Address - Street 1:21215 DETROIT RD APT A106
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-2256
Practice Address - Country:US
Practice Address - Phone:330-774-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.026704225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty