Provider Demographics
NPI:1013381839
Name:HALL, COREY ANDREW (PT, DPT)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:ANDREW
Last Name:HALL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 ABERDEEN RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8124
Mailing Address - Country:US
Mailing Address - Phone:443-564-6085
Mailing Address - Fax:
Practice Address - Street 1:1600 W 41ST ST STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1504
Practice Address - Country:US
Practice Address - Phone:410-357-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2024-01-09
Deactivation Date:2023-12-30
Deactivation Code:
Reactivation Date:2024-01-09
Provider Licenses
StateLicense IDTaxonomies
MD25763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD462714ZAVLOtherMEDICARE PTAN
MD025024OtherOPTUM
MDT208 0127OtherCAREFIRST
MD9561034OtherCIGNA
MD1024591 00Medicaid
MD310275OtherJHHC