Provider Demographics
NPI:1174254510
Name:HALL, BARBARA EVETTE
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:EVETTE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 PLEASANT ST UNIT 12214
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27117-0209
Mailing Address - Country:US
Mailing Address - Phone:336-734-3603
Mailing Address - Fax:
Practice Address - Street 1:1200 LINK RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4616
Practice Address - Country:US
Practice Address - Phone:336-734-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3501225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty