Provider Demographics
NPI:1295801140
Name:HALL, SONJA ANNA (MS, ATC)
Entity type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:ANNA
Last Name:HALL
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25194 MUD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-2151
Mailing Address - Country:US
Mailing Address - Phone:218-894-8427
Mailing Address - Fax:
Practice Address - Street 1:49725 COUNTY ROAD 83
Practice Address - Street 2:
Practice Address - City:STAPLES
Practice Address - State:MN
Practice Address - Zip Code:56479
Practice Address - Country:US
Practice Address - Phone:218-894-8427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer