Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1319116 | TX |
NPI | 1083268932 |
---|---|
Provider Name | Dr. Jessica Marie Hall |
First Address | Rowlett, TX 75088-5743 |
Second Address | Rowlett, TX 75088-4595 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2019 |
Last Update Date | 29/07/2019 |