Provider Demographics
NPI:1295974830
Name:HALL, JENNIFER MORRIS (LAT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MORRIS
Last Name:HALL
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:JO
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAT
Mailing Address - Street 1:847 WAKE FOREST BUSINESS PARK
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6575
Mailing Address - Country:US
Mailing Address - Phone:919-562-9410
Mailing Address - Fax:919-562-2948
Practice Address - Street 1:847 WAKE FOREST BUSINESS PARK
Practice Address - Street 2:SUITE 202
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6575
Practice Address - Country:US
Practice Address - Phone:919-562-9410
Practice Address - Fax:919-562-2948
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC069702556OtherNATA BOARD OF CERTIFICATION NUMBER
NC0133OtherNORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS STATE LICENSE