Healthcare Provider Details

I. General information

NPI: 1558975698
Provider Name (Legal Business Name): DANIEL JOHN HALLIGAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2020
Last Update Date: 11/27/2023
Certification Date: 09/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 N DOROTHEA WAY
SALT LAKE CITY UT
84116-1539
US

IV. Provider business mailing address

832 N DOROTHEA WAY
SALT LAKE CITY UT
84116-1539
US

V. Phone/Fax

Practice location:
  • Phone: 801-833-9537
  • Fax:
Mailing address:
  • Phone: 801-833-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: