Provider Demographics
NPI:1700080694
Name:HALL, VIELKA J (LMT)
Entity Type:Individual
Prefix:
First Name:VIELKA
Middle Name:J
Last Name:HALL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12536 SW 126TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-9037
Mailing Address - Country:US
Mailing Address - Phone:305-670-0055
Mailing Address - Fax:305-670-0054
Practice Address - Street 1:7400 N KENDALL DR
Practice Address - Street 2:SUITE 109
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7706
Practice Address - Country:US
Practice Address - Phone:305-670-0055
Practice Address - Fax:305-670-0054
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 6872225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist