Provider Demographics
NPI:1265930291
Name:HALE, VIRON (PT, DPT, ATC,CSCS)
Entity type:Individual
Prefix:MR
First Name:VIRON
Middle Name:
Last Name:HALE
Suffix:
Gender:
Credentials:PT, DPT, ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 ARGYLE AVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4202
Mailing Address - Country:US
Mailing Address - Phone:716-430-5106
Mailing Address - Fax:
Practice Address - Street 1:7505 NC 73 HWY STE D&E
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-9224
Practice Address - Country:US
Practice Address - Phone:704-587-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050616225100000X
NY0033382255A2300X
NCP23940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty