MEDICARE: MARY PAT HALL PHYSICAL THERAPY INC

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	PT14997	CA

General Provider Information

NPI Number	:	1952310583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY PAT HALL PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	12630 MONTE VISTA RD
Second Line	:	SUITE 101
City	:	POWAY
State	:	CA
Zip	:	92064-2530
Country	:	US
Telephone Number	:	858-485-7103
Fax Number	:	858-485-7107

Provider Business Practice Location Address
First Line	:	12630 MONTE VISTA RD
Second Line	:	SUITE 101
City	:	POWAY
State	:	CA
Zip	:	92064-2530
Country	:	US
Telephone Number	:	858-485-7103
Fax Number	:	858-485-7107

Authorized Official
Title or Position	:	PHYSICAL THERAPIST / OWNER
Name	:	MRS. MARY PAT HALL
Credential	:	P.T.
Telephone Number	:	858-485-7103

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	02/01/2018

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