Individual
THOMAS LAURENCE HALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
61 ERNEST AVE, WORCESTER, MA 01604-2352
(508) 688-9179
Mailing address
61 ERNEST AVE, WORCESTER, MA 01604-2352
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT005074
PA
Other
Enumeration date
09/30/2011
Last updated
09/30/2011
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