=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104139849
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER T HALL PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2010
-----------------------------------------------------
Last Update Date | 07/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 314 E 1ST ST
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-2927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-443-9884
-----------------------------------------------------
Fax | 315-410-5554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6319 FLY RD SUITE 3
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-9357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-410-6200
-----------------------------------------------------
Fax | 315-451-2095
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 032861
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------