Healthcare Provider Details

I. General information

NPI: 1710535083
Provider Name (Legal Business Name): MARY ELIZABETH HALANEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 RESEARCH BLVD STE 2-350
AUSTIN TX
78759-6586
US

IV. Provider business mailing address

11521 HEATHROW DR
AUSTIN TX
78759-4427
US

V. Phone/Fax

Practice location:
  • Phone: 512-710-6516
  • Fax:
Mailing address:
  • Phone: 512-913-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1046639
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number1046639
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: