Provider Demographics
NPI:1336888411
Name:TASAICO, HALEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:TASAICO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 MASSACHUSETTS AVE APT 605
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3017
Mailing Address - Country:US
Mailing Address - Phone:919-616-8413
Mailing Address - Fax:
Practice Address - Street 1:1242 STATE AVE STE A
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3672
Practice Address - Country:US
Practice Address - Phone:360-572-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist