Provider Demographics
NPI:1104545029
Name:LALA, HAYLEY (PT, DPT)
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:
Last Name:LALA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 BALTIMORE ANNAPOLIS BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3956
Mailing Address - Country:US
Mailing Address - Phone:410-544-2500
Mailing Address - Fax:
Practice Address - Street 1:645 BALTIMORE ANNAPOLIS BLVD STE 111
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3956
Practice Address - Country:US
Practice Address - Phone:410-544-2500
Practice Address - Fax:410-384-9703
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT16319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty