MEDICARE: DR. JEREMY ERIC HALL DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1235485715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY ERIC HALL DPT

Provider Business Mailing Address
First Line	:	50 LAIDLAW AVE APT 2
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-1775
Country	:	US
Telephone Number	:	603-505-0242
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 S PEBBLE BEACH BLVD STE 204
Second Line	:
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5708
Country	:	US
Telephone Number	:	813-530-2799
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2012
Last Update Date	:	02/01/2023

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