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General NPI Number Information
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NPI Number | 1275374464
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Entity Type | Individual
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Provider Name | GRACE HALEY
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Gender | Female
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 75-165 HUALALAI RD
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City | KAILUA KONA
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State | HI
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Zip | 96740-3722
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Country | US
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Telephone | 808-329-0591
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 FOXBOROUGH DR
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City | WILLIAMSTON
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State | MI
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Zip | 48895-9206
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Country | US
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Telephone | 517-574-0059
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Fax |
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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 | 5501303121
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-5994-0
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License Number State | HI
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