Provider Demographics
NPI:1134115561
Name:HALAT, MAUREEN M (PT, OCS)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:M
Last Name:HALAT
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:E
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:62 WALDEN RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-4150
Mailing Address - Country:US
Mailing Address - Phone:717-274-5904
Mailing Address - Fax:
Practice Address - Street 1:107 W END DR
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-9320
Practice Address - Country:US
Practice Address - Phone:717-664-4980
Practice Address - Fax:717-664-4981
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005624-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1584100Medicaid
PAR78663OtherHEALTHAMERICA/HEALTHASSUR
PA502704OtherHIGHMARK BLUE SHIELD
PA01874001OtherCAPITAL BLUE CROSS
PA253134OtherMAMSI HEALTH PLAN
PA502704OtherHIGHMARK BLUE SHIELD
502704LHTMedicare ID - Type Unspecified