Provider Demographics
NPI:1780053959
Name:HALL, HEIDI (PTA)
Entity type:Individual
Prefix:MISS
First Name:HEIDI
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 EVANS RD
Mailing Address - Street 2:917
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-6984
Mailing Address - Country:US
Mailing Address - Phone:210-331-1831
Mailing Address - Fax:
Practice Address - Street 1:1234 EVANS RD
Practice Address - Street 2:917
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-6984
Practice Address - Country:US
Practice Address - Phone:210-331-1831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2091200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant