Provider Demographics
NPI:1093960817
Name:HALL, BEN (RPT)
Entity Type:Individual
Prefix:
First Name:BEN
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8021 KNUE RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1974
Mailing Address - Country:US
Mailing Address - Phone:317-841-7005
Mailing Address - Fax:317-841-7029
Practice Address - Street 1:8021 KNUE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1974
Practice Address - Country:US
Practice Address - Phone:317-841-7005
Practice Address - Fax:317-841-7029
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001897A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist