Healthcare Provider Details

I. General information

NPI: 1841227543
Provider Name (Legal Business Name): EDWIN TYLER HALE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EDWIN TYLER HALE PT

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WISTERIA PLACE
MILLBROOK AL
36054-1849
US

IV. Provider business mailing address

40 WISTERIA PLACE
MILLBROOK AL
36054-1849
US

V. Phone/Fax

Practice location:
  • Phone: 334-285-0239
  • Fax: 334-285-9689
Mailing address:
  • Phone: 334-285-0239
  • Fax: 334-285-9689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH2493
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: