Healthcare Provider Details

I. General information

NPI: 1275561490
Provider Name (Legal Business Name): REBECCA HALL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 LONG RUN RD
LOUISVILLE KY
40245-4334
US

IV. Provider business mailing address

1410 LONG RUN RD
LOUISVILLE KY
40245-4334
US

V. Phone/Fax

Practice location:
  • Phone: 502-244-8011
  • Fax: 502-244-6631
Mailing address:
  • Phone: 502-244-8011
  • Fax: 502-244-6631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA00024
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: