Provider Demographics
NPI:1760576227
Name:HALE, JANE BAGWELL (PT)
Entity Type:Individual
Prefix:MISS
First Name:JANE
Middle Name:BAGWELL
Last Name:HALE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BIENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-1406
Mailing Address - Country:US
Mailing Address - Phone:251-533-9387
Mailing Address - Fax:251-450-0072
Practice Address - Street 1:3202 OLD SHELL ROAD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607
Practice Address - Country:US
Practice Address - Phone:251-450-0070
Practice Address - Fax:251-450-0072
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist