Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 070021590 | IL |
Y | 2251X0800X | Physical Therapist - Orthopedic | 070-021590 | IL |
NPI | 1063882090 |
---|---|
Provider Name | Adam R Hall |
First Address | Sycamore, IL 60178-3175 |
Second Address | Rochelle, IL 61068-1764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2015 |
Last Update Date | 17/03/2018 |