Provider Demographics
NPI:1295604353
Name:SOUMAHORO HALL, OLAYWAH LEWIS
Entity type:Individual
Prefix:
First Name:OLAYWAH LEWIS
Middle Name:
Last Name:SOUMAHORO 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 1:902 TANNER RD
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-4518
Mailing Address - Country:US
Mailing Address - Phone:254-245-0197
Mailing Address - Fax:
Practice Address - Street 1:3106 S W S YOUNG DR # A102
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-2000
Practice Address - Country:US
Practice Address - Phone:254-628-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-05
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist