Healthcare Provider Details

I. General information

NPI: 1417570532
Provider Name (Legal Business Name): COREY HALL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 12/30/2023
Certification Date: 12/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 41ST ST STE 300
BALTIMORE MD
21211-1504
US

IV. Provider business mailing address

1636 ABERDEEN RD
TOWSON MD
21286-8124
US

V. Phone/Fax

Practice location:
  • Phone: 410-357-1529
  • Fax:
Mailing address:
  • Phone: 443-564-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COREY ANDREW HALL
Title or Position: OWNER
Credential: PT, DPT
Phone: 443-564-6085