Healthcare Provider Details

I. General information

NPI: 1407215106
Provider Name (Legal Business Name): JACQUELYN HALE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2016
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 WIRE RD
AUBURN AL
36849-5419
US

IV. Provider business mailing address

6254 WARM SPRINGS RD APT E-17
COLUMBUS GA
31909-9133
US

V. Phone/Fax

Practice location:
  • Phone: 334-844-1694
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: