Provider Demographics
NPI:1184773251
Name:HALL, MARK ADAM (PT, OMT, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ADAM
Last Name:HALL
Suffix:
Gender:M
Credentials:PT, OMT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 PALOMINO LN STE 501
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6448
Mailing Address - Country:US
Mailing Address - Phone:603-627-6381
Mailing Address - Fax:603-627-6021
Practice Address - Street 1:82 PALOMINO LN STE 501
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6448
Practice Address - Country:US
Practice Address - Phone:603-627-6381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH9406774OtherPHCS
NHAA37427OtherHARVARD PILGRIM
NH5656604OtherFIRST HEALTH, HCVM
NH08Y008490NH01OtherANTHEM
NH0653546OtherCIGNA
NH30393905Medicaid
NH1101386OtherAETNA
NH08Y008490NH01OtherANTHEM