=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093107005
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER HALL DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2015
-----------------------------------------------------
Last Update Date | 02/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 466 GERMANTOWN PIKE
-----------------------------------------------------
City | LAFAYETTE HILL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19444-1805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-832-7510
-----------------------------------------------------
Fax | 610-832-5964
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 W GERMANTOWN PIKE SUITE 100
-----------------------------------------------------
City | PLYMOUTH MEETING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19462-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-270-0370
-----------------------------------------------------
Fax | 610-270-0374
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | PT024272
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------