Provider Demographics
NPI:1801315759
Name:HALYE, LARRY GENE JR (LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:GENE
Last Name:HALYE
Suffix:JR
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MOORES HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-6219
Mailing Address - Country:US
Mailing Address - Phone:570-578-5980
Mailing Address - Fax:
Practice Address - Street 1:1515 W 23RD ST
Practice Address - Street 2:
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-1647
Practice Address - Country:US
Practice Address - Phone:570-459-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARTO0004372255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer