Healthcare Provider Details

I. General information

NPI: 1912323023
Provider Name (Legal Business Name): JESSIE HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19780 NEW GOTTENGEN RD
SALESVILLE OH
43778-9700
US

IV. Provider business mailing address

19780 NEW GOTTENGEN RD
SALESVILLE OH
43778-9700
US

V. Phone/Fax

Practice location:
  • Phone: 740-801-0518
  • Fax:
Mailing address:
  • Phone: 740-801-0518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number07117
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: