Provider Demographics
NPI:1669592879
Name:LEHAITRE, ARIEL MARVIN (PT)
Entity type:Individual
Prefix:MS
First Name:ARIEL
Middle Name:MARVIN
Last Name:LEHAITRE
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 1:101 OAK RIM WAY
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3486
Mailing Address - Country:US
Mailing Address - Phone:408-656-3156
Mailing Address - Fax:
Practice Address - Street 1:15047 LOS GATOS BLVD STE 180
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2054
Practice Address - Country:US
Practice Address - Phone:408-358-6505
Practice Address - Fax:408-358-6404
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB51724732251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic