Healthcare Provider Details

I. General information

NPI: 1336062983
Provider Name (Legal Business Name): LEROY T HALL SR. LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11437 SW DAVIES RD APT 1516
BEAVERTON OR
97007-7691
US

IV. Provider business mailing address

11437 SW DAVIES RD APT 1516
BEAVERTON OR
97007-7691
US

V. Phone/Fax

Practice location:
  • Phone: 971-451-8806
  • Fax:
Mailing address:
  • Phone: 971-451-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number28915
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: