Provider Demographics
NPI:1508238197
Name:HALL, GERMAN ANDRES II (MS, ATC, LAT, PES)
Entity Type:Individual
Prefix:
First Name:GERMAN
Middle Name:ANDRES
Last Name:HALL
Suffix:II
Gender:M
Credentials:MS, ATC, LAT, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9951 12TH WAY N
Mailing Address - Street 2:12-113
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-5064
Mailing Address - Country:US
Mailing Address - Phone:240-427-7600
Mailing Address - Fax:
Practice Address - Street 1:4200 54TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-4744
Practice Address - Country:US
Practice Address - Phone:240-427-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL32762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2255A2300XOtherINDIVIDUAL