Basic Information
Provider Information | |||||||||
NPI: | 1740509314 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HALLETT ENTERPRISES, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | PT LINK | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 256 S GORDON DR | ||||||||
Address2: |   | ||||||||
City: | OAK HARBOR | ||||||||
State: | OH | ||||||||
PostalCode: | 434491541 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8663120054 | ||||||||
FaxNumber: | 8662685006 | ||||||||
Practice Location | |||||||||
Address1: | 256 S GORDON DR | ||||||||
Address2: |   | ||||||||
City: | OAK HARBOR | ||||||||
State: | OH | ||||||||
PostalCode: | 434491541 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4193503347 | ||||||||
FaxNumber: | 8662685006 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/21/2010 | ||||||||
LastUpdateDate: | 03/22/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HALLETT | ||||||||
AuthorizedOfficialFirstName: | THOMAS | ||||||||
AuthorizedOfficialMiddleName: | JAMES | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 4193503347 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: | II | ||||||||
AuthorizedOfficialCredential: | PT | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 10498 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.