Healthcare Provider Details

I. General information

NPI: 1801460175
Provider Name (Legal Business Name): HALEY PHILLIPS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3349 WILBUR DR
LIMA OH
45805-4504
US

IV. Provider business mailing address

30100 CHAGRIN BLVD STE 350
CLEVELAND OH
44124-5705
US

V. Phone/Fax

Practice location:
  • Phone: 419-204-7342
  • Fax:
Mailing address:
  • Phone: 330-716-3271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HALEY PHILLIPS
Title or Position: OWNER
Credential:
Phone: 419-204-7342