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General NPI Number Information
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NPI Number | 1831503234
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Entity Type | Individual
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Provider Name | JUANITA HALL PTA
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Gender | Female
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 6539 KNIGHT ARNOLD ROAD EXT
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City | MEMPHIS
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State | TN
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Zip | 38115-0697
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Country | US
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Telephone | 901-654-3070
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Fax |
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Provider Business Mailing Address
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Address Line | 10641 STARK ACRES RD
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-4102
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Country | US
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Telephone | 901-262-2613
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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 | 1850
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License Number State | TN
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