MEDICARE: ALAN LEE HALL PHYSICAL THERAPIST

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	PT00003834	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427032820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN LEE HALL PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	11481 SW HALL BLVD
Second Line	:	STE 201
City	:	PORTLAND
State	:	OR
Zip	:	97223-8403
Country	:	US
Telephone Number	:	800-219-8835
Fax Number	:	503-443-1402

Provider Business Practice Location Address
First Line	:	514 E YELM AVE
Second Line	:
City	:	YELM
State	:	WA
Zip	:	98597-9481
Country	:	US
Telephone Number	:	360-458-2444
Fax Number	:	360-458-2747

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	11/07/2007

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