Healthcare Provider Details

I. General information

NPI: 1700981214
Provider Name (Legal Business Name): MRS. MARY HOUTS HALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2362 TWO NOTCH RD
COLUMBIA SC
29204-2257
US

IV. Provider business mailing address

2362 TWO NOTCH RD COLUMBIA REHABILITATION CLINIC
COLUMBIA SC
29204-2257
US

V. Phone/Fax

Practice location:
  • Phone: 803-799-7007
  • Fax: 803-256-8410
Mailing address:
  • Phone: 803-799-7007
  • Fax: 803-256-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number613
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: