Provider Demographics
NPI:1629568597
Name:HALSEY, EMMA JULENE (AAS)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:JULENE
Last Name:HALSEY
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3168 AMANDA GAYLE CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2602
Mailing Address - Country:US
Mailing Address - Phone:908-632-4411
Mailing Address - Fax:
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR STE 170
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2986
Practice Address - Country:US
Practice Address - Phone:907-562-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK129759225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant