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NPI Code Detail

MEDICARE: LUCIE ANNE HAISEN PT, MPT

MEDICARE: LUCIE ANNE HAISEN PT, MPT
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
12251P0200XPediatric Physical Therapist30172CA

General Provider Information

NPI Number : 1568240919
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUCIE ANNE HAISEN PT, MPT
Provider Business Mailing Address
First Line : 3737 MARTIN LUTHER KING JR BLVD STE 604
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-3518
Country : US
Telephone Number : 562-333-3700
Fax Number :
Provider Business Practice Location Address
First Line : 3737 MARTIN LUTHER KING JR BLVD STE 604
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-3518
Country : US
Telephone Number : 562-333-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2023
Last Update Date : 09/18/2023

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