Provider Demographics
NPI:1730501149
Name:HALE, CHARITY TYREE (ATC)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:TYREE
Last Name:HALE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-1860
Mailing Address - Country:US
Mailing Address - Phone:540-965-1400
Mailing Address - Fax:540-965-1404
Practice Address - Street 1:606 S LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1900
Practice Address - Country:US
Practice Address - Phone:540-965-1410
Practice Address - Fax:540-965-5870
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260007232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer