Provider Demographics
NPI:1790843688
Name:HALEY, MICHAEL T (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:HALEY
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 1:7880 STEUBEN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND PATENT
Mailing Address - State:NY
Mailing Address - Zip Code:13354-3839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 E CHESTNUT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2834
Practice Address - Country:US
Practice Address - Phone:315-337-7952
Practice Address - Fax:315-337-0991
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018456-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist