Provider Demographics
NPI:1699311910
Name:CRUM, HALLEY (ATC, LAT)
Entity type:Individual
Prefix:
First Name:HALLEY
Middle Name:
Last Name:CRUM
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E COUNTY ROAD 450 N
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-9717
Mailing Address - Country:US
Mailing Address - Phone:765-309-2826
Mailing Address - Fax:
Practice Address - Street 1:2325 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1220
Practice Address - Country:US
Practice Address - Phone:765-973-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer