Provider Demographics
NPI:1053539601
Name:HAILE, ANNE (PT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:HAILE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 AMESBURY COURT
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 OLD SOLOMONS ISLAND RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3853
Practice Address - Country:US
Practice Address - Phone:410-647-7326
Practice Address - Fax:410-774-5175
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZA8XOtherMEDICARE SUFFIX
MD134652OtherPTAN
MD134653ZA8XOtherGROUP MEMBER PROVIDER #