Provider Demographics
NPI:1386004927
Name:HALL PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:HALL PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:712-574-4410
Mailing Address - Street 1:871 E SAWGRASS TRL
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5198
Mailing Address - Country:US
Mailing Address - Phone:712-574-4410
Mailing Address - Fax:605-422-0226
Practice Address - Street 1:871 E SAWGRASS TRL
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5198
Practice Address - Country:US
Practice Address - Phone:712-574-4410
Practice Address - Fax:605-422-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1369261QP2000X
SD0986261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy