Healthcare Provider Details

I. General information

NPI: 1508860131
Provider Name (Legal Business Name): BRITT HALEY ALLEN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 E MAIN ST
MADISONVILLE TX
77864-2229
US

IV. Provider business mailing address

PO BOX 1688 2703 E MAIN
MADISONVILLE TX
77864-6688
US

V. Phone/Fax

Practice location:
  • Phone: 936-348-9916
  • Fax: 936-348-9936
Mailing address:
  • Phone: 936-870-3475
  • Fax: 936-870-3476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1085603
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: