Provider Demographics
NPI:1891175105
Name:MCGONAGILL, HALEY HARRELL (DPT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:HARRELL
Last Name:MCGONAGILL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:ELENA
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6000 RAMSEY ST STE 108
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-7189
Mailing Address - Country:US
Mailing Address - Phone:910-484-3332
Mailing Address - Fax:910-483-7301
Practice Address - Street 1:6000 RAMSEY ST STE 108
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-7189
Practice Address - Country:US
Practice Address - Phone:910-484-3332
Practice Address - Fax:910-483-7301
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist