Healthcare Provider Details

I. General information

NPI: 1497170419
Provider Name (Legal Business Name): DAVID ANDREW HALL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 HERITAGE STE K
BROUSSARD LA
70518-8046
US

IV. Provider business mailing address

1019 KALISTE SALOOM RD APT 1313
LAFAYETTE LA
70508-4956
US

V. Phone/Fax

Practice location:
  • Phone: 337-214-1244
  • Fax: 866-825-4104
Mailing address:
  • Phone: 228-238-8503
  • Fax: 866-825-4104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10633R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: