Provider Demographics
NPI:1225291602
Name:HALLIBURTON, K ERRI MICHELLE (PTA)
Entity Type:Individual
Prefix:
First Name:K ERRI
Middle Name:MICHELLE
Last Name:HALLIBURTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HEALTH CARE DR
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37030-1168
Mailing Address - Country:US
Mailing Address - Phone:615-735-0569
Mailing Address - Fax:615-735-3210
Practice Address - Street 1:112 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-1168
Practice Address - Country:US
Practice Address - Phone:615-735-0569
Practice Address - Fax:615-735-3210
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2542225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant