Provider Demographics
NPI:1861417107
Name:HALL, JEANNE M (PT)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDHP25720OtherHEALTHPARTNERS #
ND13Q80HAOtherMNBS #
NDND200118OtherLHS #
ND14873OtherNDBS #
ND6402286OtherMEDICA #
ND50679Medicaid
ND974512OtherAMERICA'S PPO/ARAZ #
ND6401676OtherMEDICA #
NDDA9011015523OtherPREFERRED ONE#
ND50679Medicaid
ND6402286OtherMEDICA #
NDDA9011015523OtherPREFERRED ONE#
NDHP25720OtherHEALTHPARTNERS #