Healthcare Provider Details

I. General information

NPI: 1619207909
Provider Name (Legal Business Name): SHEILA KIRSTAN HALL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 EASTERN BYP STE. A
RICHMOND KY
40475-2569
US

IV. Provider business mailing address

489 CROMWELL WAY
LEXINGTON KY
40503-4346
US

V. Phone/Fax

Practice location:
  • Phone: 859-625-5986
  • Fax: 859-625-5987
Mailing address:
  • Phone: 859-492-5644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004664
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: