Provider Demographics
NPI:1821280025
Name:HALL, RAYMOND (MMGT, L/ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:MMGT, L/ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3753 HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:ND
Mailing Address - Zip Code:58530-9508
Mailing Address - Country:US
Mailing Address - Phone:701-794-3279
Mailing Address - Fax:
Practice Address - Street 1:3753 HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:ND
Practice Address - Zip Code:58530-9508
Practice Address - Country:US
Practice Address - Phone:701-794-3279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND155-962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer