MEDICARE: PAUL HANS HASENYAGER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT13708	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT13708	OTHER	CA	PT LICENSE

General Provider Information

NPI Number	:	1063434421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL HANS HASENYAGER PT

Provider Business Mailing Address
First Line	:	19531 BEACH BLVD
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-2902
Country	:	US
Telephone Number	:	714-960-7995
Fax Number	:	714-960-1884

Provider Business Practice Location Address
First Line	:	19531 BEACH BLVD
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-2902
Country	:	US
Telephone Number	:	714-960-7995
Fax Number	:	714-960-1884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	05/13/2009

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