Provider Demographics
NPI:1851688287
Name:GAGNE, HALINA MARIA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:HALINA
Middle Name:MARIA
Last Name:GAGNE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 THOMPSON RD.
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13221
Mailing Address - Country:US
Mailing Address - Phone:315-453-4667
Mailing Address - Fax:
Practice Address - Street 1:6820 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13211-1321
Practice Address - Country:US
Practice Address - Phone:315-453-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001347-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker