Provider Demographics
NPI:1679517536
Name:HALL, SCOTT L (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:HALL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 JENNA LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1432
Mailing Address - Country:US
Mailing Address - Phone:208-659-7553
Mailing Address - Fax:512-394-7711
Practice Address - Street 1:1425 JENNA LN
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1432
Practice Address - Country:US
Practice Address - Phone:208-659-7553
Practice Address - Fax:512-394-7711
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1212938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID650019831OtherRAILROAD MEDICARE
IDT6319OtherBLUE CROSS
ID004401100Medicaid
ID000010022103OtherREGENCE
IDT6319OtherBLUE CROSS