Provider Demographics
NPI:1033173653
Name:HALLING, ALAN HARRY (PT)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:HARRY
Last Name:HALLING
Suffix:
Gender:M
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:PO BOX 22053
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-0053
Mailing Address - Country:US
Mailing Address - Phone:602-510-4800
Mailing Address - Fax:602-652-0133
Practice Address - Street 1:3226 E LAZY LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4951
Practice Address - Country:US
Practice Address - Phone:602-510-4800
Practice Address - Fax:602-652-0133
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035439Medicaid
AZZ102206Medicare ID - Type UnspecifiedGROUP
AZ035439Medicaid