Provider Demographics
NPI:1396980678
Name:HALEY, MARY BETH (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:HALEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-3785
Mailing Address - Country:US
Mailing Address - Phone:864-940-3317
Mailing Address - Fax:
Practice Address - Street 1:10626 CLEMSON BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4526
Practice Address - Country:US
Practice Address - Phone:846-482-0085
Practice Address - Fax:864-482-0082
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist