Provider Demographics
NPI:1811032667
Name:HALL, ANN MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:HALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:DANDREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:512 SAYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4788
Mailing Address - Country:US
Mailing Address - Phone:860-343-5997
Mailing Address - Fax:860-343-6042
Practice Address - Street 1:512 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4788
Practice Address - Country:US
Practice Address - Phone:860-343-5997
Practice Address - Fax:860-343-6042
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP3367547OtherOXFORD
CT2V3991OtherPHS HEALTHNET
CT6407276OtherUHC
CT080006421CT06OtherBCBS
CT2841185OtherAETNA
650000834Medicare ID - Type Unspecified
CT2841185OtherAETNA