MEDICARE: JOHN HADDAD

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7098	OTHER	MN	LICENSE #

General Provider Information

NPI Number	:	1467569251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN HADDAD

Provider Business Mailing Address
First Line	:	440 2ND ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2011
Country	:	US
Telephone Number	:	612-382-8272
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 N SAINT PAUL RD
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-4706
Country	:	US
Telephone Number	:	651-779-8550
Fax Number	:

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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