Provider Demographics
NPI:1861786675
Name:COMOLA, HALEY MICHELLE (PT)
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:MICHELLE
Last Name:COMOLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:HALEY
Other - Middle Name:MICHELLE
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14450 S OUTER 40 RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5711
Mailing Address - Country:US
Mailing Address - Phone:314-434-6060
Mailing Address - Fax:314-434-6066
Practice Address - Street 1:14450 S OUTER 40 RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5711
Practice Address - Country:US
Practice Address - Phone:314-434-6060
Practice Address - Fax:314-434-6066
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011021968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist