Provider Demographics
NPI:1053094227
Name:HAAS, NINA SAO (DPT)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:SAO
Last Name:HAAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:
Other - Last Name:SAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11906 VIA ZAPATA
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4039
Mailing Address - Country:US
Mailing Address - Phone:619-396-7746
Mailing Address - Fax:
Practice Address - Street 1:3 CONWAY ST UNIT 103
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-7517
Practice Address - Country:US
Practice Address - Phone:619-396-7746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME6447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist