MEDICARE: CAROL ANN HALLIGAN PT

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	15373	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376107169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL ANN HALLIGAN PT

Provider Business Mailing Address
First Line	:	PO BOX 680
Second Line	:
City	:	RIDERWOOD
State	:	MD
Zip	:	21139-0680
Country	:	US
Telephone Number	:	937-602-3501
Fax Number	:	214-305-3399

Provider Business Practice Location Address
First Line	:	800 SOUTHERLY RD
Second Line	:
City	:	TOWSON
State	:	MD
Zip	:	21286-8403
Country	:	US
Telephone Number	:	410-339-6200
Fax Number	:	410-339-6060

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

Provider Enumeration Date	:	04/26/2019
Last Update Date	:	06/11/2019

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