Provider Demographics
NPI:1063842458
Name:HALKES, MARLEIGH JO (ATC)
Entity Type:Individual
Prefix:
First Name:MARLEIGH
Middle Name:JO
Last Name:HALKES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5847
Mailing Address - Country:US
Mailing Address - Phone:609-432-2724
Mailing Address - Fax:
Practice Address - Street 1:7115 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-5847
Practice Address - Country:US
Practice Address - Phone:609-432-2724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001788002255A2300X
PART0050952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer