MEDICARE: JERRI BETH HALLMAN PTA

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	1762	SC

General Provider Information

NPI Number	:	1982786422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRI BETH HALLMAN PTA

Provider Business Mailing Address
First Line	:	136 FIELD MOUNT RD
Second Line	:
City	:	HOPKINS
State	:	SC
Zip	:	29061-9053
Country	:	US
Telephone Number	:	803-622-6313
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 FIELD MOUNT RD
Second Line	:
City	:	HOPKINS
State	:	SC
Zip	:	29061-9053
Country	:	US
Telephone Number	:	803-622-6313
Fax Number	:

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	09/24/2016

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