Provider Demographics
NPI:1801995428
Name:HALLAK, AYLEE A (MPT)
Entity type:Individual
Prefix:MS
First Name:AYLEE
Middle Name:A
Last Name:HALLAK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NE 162ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4226
Mailing Address - Country:US
Mailing Address - Phone:954-326-1945
Mailing Address - Fax:
Practice Address - Street 1:1125 NE 125TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5014
Practice Address - Country:US
Practice Address - Phone:305-899-0266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21970225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY078WZMedicare ID - Type Unspecified