Provider Demographics
NPI:1508210022
Name:HALL, ANGELA NECHELE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:NECHELE
Last Name:HALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:NECHELE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2015 EAST PINETREE BLVD
Mailing Address - Street 2:APT L5
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792
Mailing Address - Country:US
Mailing Address - Phone:850-321-6233
Mailing Address - Fax:
Practice Address - Street 1:1329 ABRAHAM STREET
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304
Practice Address - Country:US
Practice Address - Phone:850-224-8486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25143225100000X
GAPT012151225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist