1134115561 NPI number — MAUREEN M HALAT P.T., O.C.S.

Table of content: MAUREEN M HALAT P.T., O.C.S. (NPI 1134115561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134115561 NPI number — MAUREEN M HALAT P.T., O.C.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALAT
Provider First Name:
MAUREEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T., O.C.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILLER
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134115561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
62 WALDEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17042-4150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-274-5904
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 W END DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHEIM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17545-9320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-664-4980
Provider Business Practice Location Address Fax Number:
717-664-4981
Provider Enumeration Date:
09/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT005624-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1584100 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: R78663 . This is a "HEALTHAMERICA/HEALTHASSUR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 502704 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01874001 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 253134 . This is a "MAMSI HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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