MEDICARE: GREGORY MARTIN HANEY DPT

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	18312	MA

General Provider Information

NPI Number	:	1184957417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY MARTIN HANEY DPT

Provider Business Mailing Address
First Line	:	350 MAIN ST
Second Line	:	FIRST FLOOR
City	:	MALDEN
State	:	MA
Zip	:	02148-5089
Country	:	US
Telephone Number	:	781-321-2727
Fax Number	:	781-321-4995

Provider Business Practice Location Address
First Line	:	350 MAIN ST
Second Line	:	FIRST FLOOR
City	:	MALDEN
State	:	MA
Zip	:	02148-5089
Country	:	US
Telephone Number	:	781-321-2727
Fax Number	:	781-321-4995

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

Provider Enumeration Date	:	09/18/2009
Last Update Date	:	09/18/2009

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