Healthcare Provider Details

I. General information

NPI: 1982962171
Provider Name (Legal Business Name): JAKKE LOU HALL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 12TH AVE N STE 20W
BILLINGS MT
59101-7518
US

IV. Provider business mailing address

2900 12TH AVE N STE 20W
BILLINGS MT
59101-7518
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-7100
  • Fax: 406-238-6855
Mailing address:
  • Phone: 406-237-7100
  • Fax: 406-238-6855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTP-PT-LIC-223
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: