Provider Demographics
NPI:1215502869
Name:GHESQUIRE, HALLI (MAT, AT, ATC)
Entity type:Individual
Prefix:
First Name:HALLI
Middle Name:
Last Name:GHESQUIRE
Suffix:
Gender:F
Credentials:MAT, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 WATSON ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:MI
Mailing Address - Zip Code:48133-9631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:974 WATSON ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:MI
Practice Address - Zip Code:48133-9631
Practice Address - Country:US
Practice Address - Phone:207-479-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010028802255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer