Provider Demographics
NPI:1134345820
Name:HALL, JASON ROBERT (MSPT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:ROBERT
Last Name:HALL
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1400 N DUTTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4657
Mailing Address - Country:US
Mailing Address - Phone:707-523-2848
Mailing Address - Fax:707-523-2866
Practice Address - Street 1:1400 N DUTTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4657
Practice Address - Country:US
Practice Address - Phone:707-523-2848
Practice Address - Fax:707-523-2866
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist