Provider Demographics
NPI:1487734992
Name:HALLETT, THOMAS J II (PT,DPT,CERT,MDT,CKTP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:HALLETT
Suffix:II
Gender:M
Credentials:PT,DPT,CERT,MDT,CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 S GORDON DR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-1541
Mailing Address - Country:US
Mailing Address - Phone:419-559-5591
Mailing Address - Fax:866-268-5006
Practice Address - Street 1:4210 W SYLVANIA AVE STE 102
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4501
Practice Address - Country:US
Practice Address - Phone:419-559-5591
Practice Address - Fax:866-268-5006
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 010498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2632173Medicaid
OH4175433Medicare PIN