Provider Demographics
NPI:1144507864
Name:EGESDAHL, HALEY ALICIA (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:HALEY
Middle Name:ALICIA
Last Name:EGESDAHL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 CASTLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-6907
Mailing Address - Country:US
Mailing Address - Phone:706-616-3592
Mailing Address - Fax:
Practice Address - Street 1:695 CASTLEVIEW DR
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-6907
Practice Address - Country:US
Practice Address - Phone:706-616-3592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist