Healthcare Provider Details

I. General information

NPI: 1568426393
Provider Name (Legal Business Name): DOUGLAS EUGENE HALADAY PT,MHS,DPT,OCS,CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 ROUTE 611 SUITE 3, BARTONSVILLE COMMONS
BARTONSVILLE PA
18321-9439
US

IV. Provider business mailing address

1850 BECKS CROSSING RD
MADISON TOWNSHIP PA
18444-7526
US

V. Phone/Fax

Practice location:
  • Phone: 570-619-7370
  • Fax:
Mailing address:
  • Phone: 570-842-3252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT008437L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: