Provider Demographics
NPI:1174558423
Name:HALL, JAMES MATTHEW (PT, OCS)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MATTHEW
Last Name:HALL
Suffix:
Gender:M
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4101 TATES CREEK CENTRE DR STE 144
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3068
Mailing Address - Country:US
Mailing Address - Phone:859-271-2887
Mailing Address - Fax:859-271-2889
Practice Address - Street 1:4101 TATES CREEK CENTRE DR STE 144
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3068
Practice Address - Country:US
Practice Address - Phone:859-271-2887
Practice Address - Fax:859-271-2889
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist