MEDICARE: KATHRYN J HAALAND RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	007331	CT

General Provider Information

NPI Number	:	1104825322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN J HAALAND RPT

Provider Business Mailing Address
First Line	:	PO BOX 88
Second Line	:
City	:	EAST LYME
State	:	CT
Zip	:	06333-0088
Country	:	US
Telephone Number	:	860-739-4497
Fax Number	:	860-739-7256

Provider Business Practice Location Address
First Line	:	131 BOSTON POST RD
Second Line	:
City	:	EAST LYME
State	:	CT
Zip	:	06333-1605
Country	:	US
Telephone Number	:	860-739-4497
Fax Number	:	860-739-7256

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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