Provider Demographics
NPI:1659390243
Name:HALLERAN, CYNTHIA ERIN (PT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ERIN
Last Name:HALLERAN
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 1:1202 KING JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-7817
Mailing Address - Country:US
Mailing Address - Phone:630-443-6719
Mailing Address - Fax:630-443-6719
Practice Address - Street 1:1202 KING JAMES AVE
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-7817
Practice Address - Country:US
Practice Address - Phone:630-443-6719
Practice Address - Fax:630-443-6719
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist