Healthcare Provider Details

I. General information

NPI: 1336760818
Provider Name (Legal Business Name): HALEY LLAMAS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17055 FRANCES ST STE 100
OMAHA NE
68130-4655
US

IV. Provider business mailing address

17055 FRANCES ST STE 100
OMAHA NE
68130-4655
US

V. Phone/Fax

Practice location:
  • Phone: 402-280-3555
  • Fax: 402-280-3557
Mailing address:
  • Phone: 402-280-3555
  • Fax: 402-280-3557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT298333
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: