MEDICARE: HALEY GILL DPT, OCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070.021295	IL
2	2251X0800X	Orthopedic Physical Therapist	070.021.295	IL

General Provider Information

NPI Number	:	1154707487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY GILL DPT, OCS

Provider Business Mailing Address
First Line	:	221 3RD ST W BLDG 1040
Second Line	:
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78150-4800
Country	:	US
Telephone Number	:	210-652-6065
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 3RD ST W BLDG 1040
Second Line	:
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78150-4800
Country	:	US
Telephone Number	:	210-652-6065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2015
Last Update Date	:	03/09/2025

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