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General NPI Number Information
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NPI Number | 1861014748
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Entity Type | Individual
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Provider Name | DUSTIN HALL PT
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Gender | Male
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 9411 S NORTHSHORE DR STE 101
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City | KNOXVILLE
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State | TN
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Zip | 37922-8820
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Country | US
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Telephone | 865-766-2796
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Fax |
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Provider Business Mailing Address
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Address Line | 202 SHERWOOD DR
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City | MARYVILLE
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State | TN
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Zip | 37801-4621
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Country | US
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Telephone | 865-724-4542
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT8036
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License Number State | TN
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