Provider Demographics
NPI:1952310583
Name:MARY PAT HALL PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MARY PAT HALL PHYSICAL THERAPY INC
Other - Org Name:PHYSICAL THERAPY INSTITUTE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PAT
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:858-485-7103
Mailing Address - Street 1:12630 MONTE VISTA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2530
Mailing Address - Country:US
Mailing Address - Phone:858-485-7103
Mailing Address - Fax:858-485-7107
Practice Address - Street 1:12630 MONTE VISTA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2530
Practice Address - Country:US
Practice Address - Phone:858-485-7103
Practice Address - Fax:858-485-7107
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PT14997
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-05
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14502Medicare ID - Type Unspecified
CAW19230Medicare PIN
CAWPT14997AMedicare ID - Type Unspecified