Healthcare Provider Details

I. General information

NPI: 1588340467
Provider Name (Legal Business Name): PETER HALLETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 CAMINO DEL RIO S. SUITE 103
SAN DIEGO CA
92108
US

IV. Provider business mailing address

1333 CAMINO DEL RIO S. SUITE 103
SAN DIEGO CA
92108
US

V. Phone/Fax

Practice location:
  • Phone: 619-501-2195
  • Fax: 619-501-2176
Mailing address:
  • Phone: 619-501-2195
  • Fax: 619-501-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT304264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: