Provider Demographics
NPI:1861743924
Name:HALLETT ENTERPRISES, LLC
Entity type:Organization
Organization Name:HALLETT ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALLETT
Authorized Official - Suffix:II
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:419-559-5591
Mailing Address - Street 1:256 S GORDON DR
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-1541
Mailing Address - Country:US
Mailing Address - Phone:419-559-5591
Mailing Address - Fax:866-268-5006
Practice Address - Street 1:3232 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3312
Practice Address - Country:US
Practice Address - Phone:419-559-5591
Practice Address - Fax:866-268-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3110369Medicaid
OH3110369Medicaid