Provider Demographics
NPI:1972038735
Name:HALL, WILLIAM M (NMT, LMT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:M
Last Name:HALL
Suffix:
Gender:M
Credentials:NMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 E CENTER ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-5348
Mailing Address - Country:US
Mailing Address - Phone:479-422-4021
Mailing Address - Fax:
Practice Address - Street 1:31 E CENTER ST
Practice Address - Street 2:SUITE 210
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5348
Practice Address - Country:US
Practice Address - Phone:479-422-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7155225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist