Healthcare Provider Details

I. General information

NPI: 1518399567
Provider Name (Legal Business Name): RYAN DAVID HALL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 DEXTER STREET
MILAN MI
48160
US

IV. Provider business mailing address

905 DEXTER STREET
MILAN MI
48160
US

V. Phone/Fax

Practice location:
  • Phone: 734-439-8410
  • Fax: 734-439-8430
Mailing address:
  • Phone: 734-439-8410
  • Fax: 734-439-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberL2261236
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: