MEDICARE: AMANDA HALLER

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	1398270	TX

General Provider Information

NPI Number	:	1316439862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA HALLER

Provider Business Mailing Address
First Line	:	838 BONNET TRL
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-7704
Country	:	US
Telephone Number	:	870-623-5353
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 S MIDLOTHIAN PKWY STE 170
Second Line	:
City	:	MIDLOTHIAN
State	:	TX
Zip	:	76065-5597
Country	:	US
Telephone Number	:	972-723-0380
Fax Number	:

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

Provider Enumeration Date	:	05/31/2018
Last Update Date	:	09/15/2024

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Directions to “ AMANDA HALLER ” Practice Location

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