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General NPI Number Information
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NPI Number | 1629852330
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Entity Type | Individual
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Provider Name | NICKI HALL LMT
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Gender | Female
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Dates
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Enumeration Date | 08/23/2023
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 115 AIKENS CTR STE 11A
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City | MARTINSBURG
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State | WV
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Zip | 25404-6210
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Country | US
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Telephone | 304-582-9065
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Fax |
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Provider Business Mailing Address
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Address Line | 182 REVOLUTIONARY RD
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City | CHARLES TOWN
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State | WV
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Zip | 25414-5576
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Country | US
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Telephone | 253-273-2833
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2023-4037
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License Number State | WV
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