Provider Demographics
NPI:1396813341
Name:HALL, AMANDA (PT, MPT, PCS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:PT, MPT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CARROLL ST NW
Mailing Address - Street 2:APT 210
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-2020
Mailing Address - Country:US
Mailing Address - Phone:202-641-5215
Mailing Address - Fax:
Practice Address - Street 1:314 CARROLL ST NW
Practice Address - Street 2:APT 210
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2020
Practice Address - Country:US
Practice Address - Phone:202-641-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT8703702251P0200X
MD236202251P0200X
OR06713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist