Healthcare Provider Details

I. General information

NPI: 1750613402
Provider Name (Legal Business Name): BARBARA J HALLERON L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 SAINT CLAIR RD
ENGLEWOOD FL
34223-1625
US

IV. Provider business mailing address

1441 ST. CLAIRE RD.
ENGLEWOOD FL
34223
US

V. Phone/Fax

Practice location:
  • Phone: 941-416-1066
  • Fax:
Mailing address:
  • Phone: 941-416-1066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License NumberMA#20566
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: