Healthcare Provider Details

I. General information

NPI: 1194853176
Provider Name (Legal Business Name): PAUL W HAERTIG L.M.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20218 77TH AVE NE STE. A
ARLINGTON WA
98223
US

IV. Provider business mailing address

20218 77TH AVE NE STE. A
ARLINGTON WA
98223
US

V. Phone/Fax

Practice location:
  • Phone: 360-435-3900
  • Fax: 360-435-1105
Mailing address:
  • Phone: 360-435-3900
  • Fax: 360-435-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00009348
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA00009348
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: