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General NPI Number Information
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NPI Number | 1023789484
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Entity Type | Individual
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Provider Name | STACY HALLER PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/25/2021
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 1040 TIERRA DEL REY STE 107
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City | CHULA VISTA
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State | CA
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Zip | 91910-7865
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Country | US
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Telephone | 619-500-5884
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 HARRISON ST, 7TH FL
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City | OAKLAND
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State | CA
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Zip | 94612-3429
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Country | US
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Telephone | 510-625-2856
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Fax | 877-738-4262
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT300797
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License Number State | CA
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