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General NPI Number Information
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NPI Number | 1619625431
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Entity Type | Individual
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Provider Name | MONICA DIANE HALE PTA
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Gender | Female
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Dates
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Enumeration Date | 03/10/2022
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 3330 E LOUISE DR STE 400
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City | MERIDIAN
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State | ID
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Zip | 83642-5123
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Country | US
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Telephone | 208-381-2138
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Fax |
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Provider Business Mailing Address
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Address Line | 6901 LEISURE LN
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City | NAMPA
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State | ID
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Zip | 83687-8727
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Country | US
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Telephone | 208-989-0425
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA-2864
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License Number State | ID
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