Healthcare Provider Details

I. General information

NPI: 1003818774
Provider Name (Legal Business Name): GRACE HALL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BLEACHERY BLVD SUITE # 201
ASHEVILLE NC
28803-8314
US

IV. Provider business mailing address

57 GREENWELLS GLORY DR
BILTMORE LAKE NC
28715-8901
US

V. Phone/Fax

Practice location:
  • Phone: 828-277-5763
  • Fax: 828-277-5764
Mailing address:
  • Phone: 828-665-4849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number4693
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: