Provider Demographics
NPI:1699959692
Name:HALLARES, MARY JT (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JT
Last Name:HALLARES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY JOY
Other - Middle Name:T
Other - Last Name:HALLARES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:85-885 FARRINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2440
Mailing Address - Country:US
Mailing Address - Phone:808-696-4764
Mailing Address - Fax:808-696-2853
Practice Address - Street 1:85-885 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2440
Practice Address - Country:US
Practice Address - Phone:808-696-4764
Practice Address - Fax:808-696-2853
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-2818174400000X
HIPT2818225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist