Provider Demographics
NPI:1366738031
Name:HALEY, KATHLEEN (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:HALEY
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 1:108 DOWNING AVE
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1912
Mailing Address - Country:US
Mailing Address - Phone:516-676-5717
Mailing Address - Fax:
Practice Address - Street 1:108 DOWNING AVE
Practice Address - Street 2:
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579-1912
Practice Address - Country:US
Practice Address - Phone:516-676-5717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014294-1225100000X
FL12857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist