MEDICARE: BRIAN HALL

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	2251X0800X	Orthopedic Physical Therapist	PT18217	FL
2	225100000X	Physical Therapist	PT18217	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18217	OTHER	FL	LICENSE #

General Provider Information

NPI Number	:	1417064239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN HALL

Provider Business Mailing Address
First Line	:	3511 DURRANCE ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-2181
Country	:	US
Telephone Number	:	727-798-7306
Fax Number	:

Provider Business Practice Location Address
First Line	:	6474 RIDGE RD
Second Line	:
City	:	PORT RICHEY
State	:	FL
Zip	:	34668-6748
Country	:	US
Telephone Number	:	727-846-0547
Fax Number	:	727-847-0755

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	08/29/2024

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Directions to “ BRIAN HALL ” Practice Location

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