Basic Information
| Provider Information | |||||||||
| NPI: | 1255594651 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | MAXINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | REV | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1715 | ||||||||
| Address2: | |||||||||
| City: | TWEMTYNINE PALMS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603694057 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 56020 SANTA FE TRL | ||||||||
| Address2: | |||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922843148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604201246 | ||||||||
| FaxNumber: | 7603699473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2008 | ||||||||
| LastUpdateDate: | 07/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.