MEDICARE: THECIA LYNN HALL LPTA

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	225200000X	Physical Therapy Assistant	4986	AL

General Provider Information

NPI Number	:	1891065215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THECIA LYNN HALL LPTA

Provider Business Mailing Address
First Line	:	3841 W 39TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-1907
Country	:	US
Telephone Number	:	720-320-8334
Fax Number	:

Provider Business Practice Location Address
First Line	:	3841 W 39TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-1907
Country	:	US
Telephone Number	:	720-320-8334
Fax Number	:

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

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

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