| Organization Name: | HAILEY PHYSCIAL THERAPY, PA |
| NPI Number: | 1578671988 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY HOGAN (OWNER/ PHYSICAL THERAPIST) |
| Mailing Address: | 21 East Maple Street Suite D Hailey |
| State: | ID US |
| Postal Code: | 83333 |
| Phone Number: | 2084810275 |
| Fax Number: | 2085787757 |
| NPI Enumeration Date: | 08/26/2006 |
| NPI Last Update Date: | 10/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 651 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |