Basic Information
| Provider Information | |||||||||
| NPI: | 1184178535 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | MADISON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 239 S LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | RUSSELL | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676652907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4346617637 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1201 CORPORATE BLVD STE 130 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895027162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758281000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2016 | ||||||||
| LastUpdateDate: | 08/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 14-03054 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | 2306604493 | VA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.