Provider Demographics
NPI:1043542624
Name:HALEY, ROSS MATHEW (DPT)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:MATHEW
Last Name:HALEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20268 PLANTATIONS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-4622
Mailing Address - Country:US
Mailing Address - Phone:302-727-0075
Mailing Address - Fax:302-727-2047
Practice Address - Street 1:20268 PLANTATIONS RD
Practice Address - Street 2:SUITE B
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4622
Practice Address - Country:US
Practice Address - Phone:302-727-0075
Practice Address - Fax:302-727-2047
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist