Provider Demographics
NPI:1386652899
Name:HALEY, KRISTI D (DPT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:D
Last Name:HALEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 EAGLES NEST PARK
Mailing Address - Street 2:SUITE E
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-2766
Mailing Address - Country:US
Mailing Address - Phone:864-882-7965
Mailing Address - Fax:864-882-7967
Practice Address - Street 1:135 EAGLES NEST PARK
Practice Address - Street 2:SUITE E
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2766
Practice Address - Country:US
Practice Address - Phone:864-882-7965
Practice Address - Fax:864-882-7967
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1648Medicaid
SCTH1648Medicaid
SCQ34222Medicare UPIN