MEDICARE: FELECIA HALEY

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	225200000X	Physical Therapy Assistant	2012514	TX

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
2	2012514	OTHER	TX	MANAGE CARE

General Provider Information

NPI Number	:	1386125011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELECIA HALEY

Provider Business Mailing Address
First Line	:	701 SAINT LOUIS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3324
Country	:	US
Telephone Number	:	817-332-9962
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 SAINT LOUIS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3324
Country	:	US
Telephone Number	:	817-933-9195
Fax Number	:

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

Provider Enumeration Date	:	08/21/2018
Last Update Date	:	08/21/2018

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Directions to “ FELECIA HALEY ” Practice Location

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