Provider Demographics
NPI:1891805701
Name:HALILI, ADI
Entity type:Individual
Prefix:
First Name:ADI
Middle Name:
Last Name:HALILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:HALILI
Other - Middle Name:PHYSICAL
Other - Last Name:THERAPY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7329 W CLEAR CANYON DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-5134
Mailing Address - Country:US
Mailing Address - Phone:520-403-6965
Mailing Address - Fax:
Practice Address - Street 1:268 E RIVER RD
Practice Address - Street 2:130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5842
Practice Address - Country:US
Practice Address - Phone:520-403-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ65347Medicare PIN