Healthcare Provider Details

I. General information

NPI: 1174144315
Provider Name (Legal Business Name): HALEY J SLAGBOOM DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11160 WJ PRESLEY PKWY STE 103
ALLENDALE MI
49401-8075
US

IV. Provider business mailing address

1311 MAMARONECK AVE STE 140
WHITE PLAINS NY
10605-5224
US

V. Phone/Fax

Practice location:
  • Phone: 616-895-4050
  • Fax: 616-965-2475
Mailing address:
  • Phone: 914-294-4050
  • Fax: 631-760-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501302977
License Number StateFM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: