MEDICARE: MR. RALPH C. HAVENS P.T.

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	PT13102	CA

General Provider Information

NPI Number	:	1679798904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RALPH C. HAVENS P.T.

Provider Business Mailing Address
First Line	:	1134 10TH ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-7049
Country	:	US
Telephone Number	:	360-599-2217
Fax Number	:

Provider Business Practice Location Address
First Line	:	928 FORT STOCKTON DR STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1893
Country	:	US
Telephone Number	:	619-543-1470
Fax Number	:	619-543-1421

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	06/03/2025

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