MEDICARE: MR. TERRENCE KEITH HALONE

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	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1508124603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TERRENCE KEITH HALONE

Provider Business Mailing Address
First Line	:	7308 NICOLLET AVE
Second Line	:
City	:	RICHFIELD
State	:	MN
Zip	:	55423-3121
Country	:	US
Telephone Number	:	612-701-7964
Fax Number	:

Provider Business Practice Location Address
First Line	:	8736 LYNDALE AVE S
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55420-2738
Country	:	US
Telephone Number	:	612-701-7964
Fax Number	:

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

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	04/26/2012

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