Healthcare Provider Details

I. General information

NPI: 1992926349
Provider Name (Legal Business Name): ERICA HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38059 TUMBLING OAKS DR
PRAIRIEVILLE LA
70769-4194
US

IV. Provider business mailing address

38059 TUMBLING OAKS DR
PRAIRIEVILLE LA
70769-4194
US

V. Phone/Fax

Practice location:
  • Phone: 318-359-8456
  • Fax:
Mailing address:
  • Phone: 318-359-8456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA8337
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number200056
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: