Individual
PEGGY NOELLE HALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DAT, LAT, ATC
Contact information
Practice address
1460 UNIVERSITY DR, WINCHESTER, VA 22601-5195
(540) 665-4566
(540) 665-4934
Mailing address
407 RIDGEFIELD AVE, STEPHENS CITY, VA 22655-2901
(804) 350-2417
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36003345A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0126003755
VIRGINIA BOARD OF MEDICINE
VA
01
—
2000038693
BOC CERTIFICATION
—
01
—
36003345A
INDIANA PROFESSIONAL LICENSING AGENCY
IN
Enumeration date
09/01/2017
Last updated
08/08/2023
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