=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245059211
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. HALEY FLOWER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2024
-----------------------------------------------------
Last Update Date | 10/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1272 RIDGE RD
-----------------------------------------------------
City | ONTARIO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14519-9101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-524-9735
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7358 FURNACE RD
-----------------------------------------------------
City | ONTARIO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14519-9723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-576-5897
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 053256
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------