Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 06002524A | IN |
NPI | 1003110750 |
---|---|
Provider Name | Laura Anne Hall |
First Address | Rensselaer, IN 47978-3211 |
Second Address | Rensselaer, IN 47978-3211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2011 |
Last Update Date | 10/01/2011 |