Provider Demographics
NPI:1518403682
Name:LONG, HALEY (PT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 FORT MILL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7697
Mailing Address - Country:US
Mailing Address - Phone:740-644-9893
Mailing Address - Fax:770-505-3595
Practice Address - Street 1:1162 FORT MILL HWY
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-7697
Practice Address - Country:US
Practice Address - Phone:740-644-9893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist