Provider Demographics
NPI:1700060761
Name:HALIBURTON, RENEE DAWN (PT)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:DAWN
Last Name:HALIBURTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-1648
Mailing Address - Country:US
Mailing Address - Phone:651-480-4168
Mailing Address - Fax:651-480-4339
Practice Address - Street 1:85 PLEASANT DR
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1648
Practice Address - Country:US
Practice Address - Phone:651-480-4168
Practice Address - Fax:651-480-4339
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6419225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist