Provider Demographics
NPI:1013142900
Name:HALLEY, DANIEL K (ATC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:K
Last Name:HALLEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 WILLIAM STREET
Mailing Address - Street 2:SUITE 152
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701
Mailing Address - Country:US
Mailing Address - Phone:573-332-1587
Mailing Address - Fax:
Practice Address - Street 1:3049 WILLIAM STREET
Practice Address - Street 2:SUITE 152
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701
Practice Address - Country:US
Practice Address - Phone:573-332-1587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080009832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPROVIDER CODE 22OtherRESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS