Provider Demographics
NPI:1336159466
Name:HALL, OLIVER D F (PT)
Entity Type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:D F
Last Name:HALL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BOBOLINK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:VT
Mailing Address - Zip Code:05452
Mailing Address - Country:US
Mailing Address - Phone:802-879-0182
Mailing Address - Fax:
Practice Address - Street 1:4 KELLOGG RD
Practice Address - Street 2:
Practice Address - City:ESSEX JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05452-2815
Practice Address - Country:US
Practice Address - Phone:802-578-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT4942874OtherCIGNA
VT1010209Medicaid
VT59059OtherBCBS
VT4942874OtherCIGNA