Provider Demographics
NPI:1235744715
Name:HALL, BOYD WAYNE (PTA)
Entity Type:Individual
Prefix:MR
First Name:BOYD
Middle Name:WAYNE
Last Name:HALL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CATER DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-8809
Mailing Address - Country:US
Mailing Address - Phone:870-761-4221
Mailing Address - Fax:
Practice Address - Street 1:2278 ALBERT PIKE RD STE B
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-4157
Practice Address - Country:US
Practice Address - Phone:501-767-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
AR4563225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant