Healthcare Provider Details

I. General information

NPI: 1679517536
Provider Name (Legal Business Name): SCOTT L HALL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 JENNA LN
CEDAR PARK TX
78613-1432
US

IV. Provider business mailing address

1425 JENNA LN
CEDAR PARK TX
78613-1432
US

V. Phone/Fax

Practice location:
  • Phone: 208-659-7553
  • Fax: 512-394-7711
Mailing address:
  • Phone: 208-659-7553
  • Fax: 512-394-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1212938
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: