MEDICARE: MRS. ANGELINE RUTH HALSTEAD PT, DPT

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	2305207119	VA

General Provider Information

NPI Number	:	1730461468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELINE RUTH HALSTEAD PT, DPT

Provider Business Mailing Address
First Line	:	11 TAFT AVE
Second Line	:	APT 4
City	:	WINCHESTER
State	:	VA
Zip	:	22601-3693
Country	:	US
Telephone Number	:	814-558-9719
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 EXETER DR
Second Line	:	SUITE 101
City	:	WINCHESTER
State	:	VA
Zip	:	22603-8614
Country	:	US
Telephone Number	:	540-665-1681
Fax Number	:	540-665-1681

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

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/20/2011

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