Provider Demographics
NPI:1891748083
Name:HALEY, MATTHEW ROY (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROY
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 1:1 NEW STREET
Mailing Address - Street 2:FRESH POND MALL
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138
Mailing Address - Country:US
Mailing Address - Phone:617-876-2660
Mailing Address - Fax:671-441-5552
Practice Address - Street 1:1 NEW ST
Practice Address - Street 2:FRESH POND MALL
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1222
Practice Address - Country:US
Practice Address - Phone:617-876-2660
Practice Address - Fax:617-441-5552
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y68922Medicare ID - Type Unspecified