Provider Demographics
NPI:1578651550
Name:HALLIDAY, MICHAEL VERE (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:VERE
Last Name:HALLIDAY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 BUSINESS PARK DR STE 203
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-2312
Mailing Address - Country:US
Mailing Address - Phone:801-253-2896
Mailing Address - Fax:801-607-3028
Practice Address - Street 1:1471 BUSINESS PARK DR STE 203
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-2312
Practice Address - Country:US
Practice Address - Phone:801-253-2896
Practice Address - Fax:801-607-3028
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT111133-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist