Provider Demographics
NPI:1003818774
Name:HALL, GRACE (PT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 GREENWELLS GLORY DR
Mailing Address - Street 2:
Mailing Address - City:BILTMORE LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28715-8901
Mailing Address - Country:US
Mailing Address - Phone:828-665-4849
Mailing Address - Fax:
Practice Address - Street 1:1201 BLEACHERY BLVD
Practice Address - Street 2:SUITE # 201
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8314
Practice Address - Country:US
Practice Address - Phone:828-277-5763
Practice Address - Fax:828-277-5764
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC46932251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10602OtherBCBS
NC7232360Medicaid
NC7232360Medicaid