1902194954 NPI number — CAITLIN MARIE HALL DPT

Table of content: CAITLIN MARIE HALL DPT (NPI 1902194954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902194954 NPI number — CAITLIN MARIE HALL DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
CAITLIN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLWELL
Provider Other First Name:
CAITLIN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902194954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
878 S ROCHESTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48307-2740
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-601-9207
Provider Business Mailing Address Fax Number:
248-650-8670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21550 HARRINGTON ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
CLINTON TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48036-2362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-783-7590
Provider Business Practice Location Address Fax Number:
586-783-7876
Provider Enumeration Date:
07/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501015659 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 650E035140 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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