Provider Demographics
NPI:1841227543
Name:HALE, EDWIN TYLER (PT)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:TYLER
Last Name:HALE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:EDWIN
Other - Middle Name:TYLER
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:40 WISTERIA PLACE
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-1849
Mailing Address - Country:US
Mailing Address - Phone:334-285-0239
Mailing Address - Fax:334-285-9689
Practice Address - Street 1:40 WISTERIA PLACE
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:AL
Practice Address - Zip Code:36054-1849
Practice Address - Country:US
Practice Address - Phone:334-285-0239
Practice Address - Fax:334-285-9689
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH2493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051556584Medicaid
AL515-30241OtherBLUE CROSS BLUE SHIELD
ALP00331773OtherMEDICARE RAILROAD
ALP00331773OtherMEDICARE RAILROAD
S73118Medicare UPIN