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General NPI Number Information
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NPI Number | 1063544914
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Entity Type | Individual
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Provider Name | MR. TOM A HALL
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Gender | Male
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1220 JEFFERSON ST
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City | LAUREL
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State | MS
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Zip | 39440-4355
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Country | US
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Telephone | 601-399-0534
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Fax |
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Provider Business Mailing Address
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Address Line | 9 SYCAMORE CIR
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City | PETAL
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State | MS
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Zip | 39465-9467
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Country | US
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Telephone | 601-583-2894
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1267
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License Number State | MS
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