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NPI Code Detail

MEDICARE: JAMES K HABERSTRO PT

MEDICARE: JAMES K HABERSTRO 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
1225100000XPhysical TherapistPT3697WA
22251G0304XGeriatric Physical TherapistPT3697WA
32251N0400XNeurology Physical Therapist
42251X0800XOrthopedic Physical Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740280254
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES K HABERSTRO PT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 630-296-2222
Fax Number : 630-759-9510
Provider Business Practice Location Address
First Line : 4935 POINT FOSDICK DR NW
Second Line : SUITES F200 & F300
City : GIG HARBOR
State : WA
Zip : 98335-1851
Country : US
Telephone Number : 253-258-3355
Fax Number : 253-258-3356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 03/07/2017

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Directions to “ JAMES K HABERSTRO PT” Practice Location

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