Individual
MARY CONSUELO HALFACRE BUIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2200 HAVASUPA BLVD, LAKE HAVASU CITY, AZ 86403-6798
(928) 505-6911
(928) 505-6991
Mailing address
2200 HAVASUPA BLVD, LAKE HAVASU CITY, AZ 86403-6798
(928) 505-6911
(928) 505-6991
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3864
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
728939
AHCCS
AZ
Enumeration date
11/16/2006
Last updated
07/08/2007
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