Provider Demographics
NPI:1265987333
Name:PHAM, HALY (CMT, MMP)
Entity type:Individual
Prefix:
First Name:HALY
Middle Name:
Last Name:PHAM
Suffix:
Gender:F
Credentials:CMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CHURCH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4452
Mailing Address - Country:US
Mailing Address - Phone:802-825-5234
Mailing Address - Fax:
Practice Address - Street 1:19 CHURCH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4452
Practice Address - Country:US
Practice Address - Phone:802-825-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist