MEDICARE: MICHAEL JONATHAN HALL DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1568207884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JONATHAN HALL DPT

Provider Business Mailing Address
First Line	:	374 E 1500 S
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84010-5128
Country	:	US
Telephone Number	:	385-375-9183
Fax Number	:

Provider Business Practice Location Address
First Line	:	4522 S 1300 E
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84117-4177
Country	:	US
Telephone Number	:	385-446-9881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2024
Last Update Date	:	06/27/2024

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