Provider Demographics
NPI:1982962171
Name:HALL, JAKKE LOU (PT)
Entity Type:Individual
Prefix:MS
First Name:JAKKE
Middle Name:LOU
Last Name:HALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N STE 20W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7518
Mailing Address - Country:US
Mailing Address - Phone:406-237-7100
Mailing Address - Fax:406-238-6855
Practice Address - Street 1:2900 12TH AVE N STE 20W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7518
Practice Address - Country:US
Practice Address - Phone:406-237-7100
Practice Address - Fax:406-238-6855
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-2232251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics