Healthcare Provider Details

I. General information

NPI: 1992385488
Provider Name (Legal Business Name): TIMOTHY ALLEN HALL MS, BCTMB-LMT, C-EP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 VALLEY WEST DR STE 404
WEST DES MOINES IA
50266-1905
US

IV. Provider business mailing address

814 46TH ST
WEST DES MOINES IA
50265-2910
US

V. Phone/Fax

Practice location:
  • Phone: 520-709-3692
  • Fax:
Mailing address:
  • Phone: 520-709-3692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number04035
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: