Provider Demographics
NPI:1659522977
Name:HAIL, PAUL DAVID JR (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:HAIL
Suffix:JR
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 1:1004 N 19TH AVE
Mailing Address - Street 2:BLDG 4
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-3016
Mailing Address - Country:US
Mailing Address - Phone:580-920-2231
Mailing Address - Fax:580-920-2242
Practice Address - Street 1:1004 N 19TH AVE
Practice Address - Street 2:BLDG 4
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-3016
Practice Address - Country:US
Practice Address - Phone:580-920-2231
Practice Address - Fax:580-920-2242
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist