Provider Demographics
NPI:1912506031
Name:EWALD, HALEY M (DPT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:M
Last Name:EWALD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18000 COVE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1383
Mailing Address - Country:US
Mailing Address - Phone:616-847-1280
Mailing Address - Fax:616-847-1290
Practice Address - Street 1:890 WASHINGTON AVE STE 130-A
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7731
Practice Address - Country:US
Practice Address - Phone:616-994-8136
Practice Address - Fax:616-994-8162
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2024-02-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501019661OtherSTATE LICENSE