Provider Demographics
NPI:1629596523
Name:HALLOWELL, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HALLOWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MARJORIE ST
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:MA
Mailing Address - Zip Code:01834-1339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 MARJORIE STREET
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:MA
Practice Address - Zip Code:01834
Practice Address - Country:US
Practice Address - Phone:978-914-2429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer