Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 4693 | NC |
NPI | 1003818774 |
---|---|
Provider Name | Grace Hall |
First Address | Biltmore Lake, NC 28715-8901 |
Second Address | Asheville, NC 28803-8314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 15/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10602 | BCBS (01) | NC |
7232360 | (05) | NC |