Provider Demographics
NPI:1598746984
Name:HALL, JOHN N (PT)
Entity Type:Individual
Prefix:MS
First Name:JOHN
Middle Name:N
Last Name:HALL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 12TH ST
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-5712
Mailing Address - Country:US
Mailing Address - Phone:801-393-0900
Mailing Address - Fax:801-394-6130
Practice Address - Street 1:349 12TH ST
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-5712
Practice Address - Country:US
Practice Address - Phone:801-393-0900
Practice Address - Fax:801-394-6130
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT112281-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005570201Medicare ID - Type Unspecified
UTR607590002Medicare UPIN