MEDICARE: COLLEEN HALLIGAN P.T.

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	174400000X	Specialist	15024	CA
2	208100000X	Physical Medicine & Rehabilitation Physician	10524	CA

General Provider Information

NPI Number	:	1336409044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN HALLIGAN P.T.

Provider Business Mailing Address
First Line	:	12572 VALLEY VIEW ST
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2006
Country	:	US
Telephone Number	:	714-823-4400
Fax Number	:	714-823-4404

Provider Business Practice Location Address
First Line	:	9990 LAKEWOOD BLVD
Second Line	:
City	:	DOWNEY
State	:	CA
Zip	:	90240-4009
Country	:	US
Telephone Number	:	562-862-7950
Fax Number	:	562-862-9973

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

Provider Enumeration Date	:	05/29/2012
Last Update Date	:	05/29/2012

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Directions to “ COLLEEN HALLIGAN P.T.” Practice Location

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