Provider Demographics
NPI:1104139849
Name:HALL, CHRISTOPHER T (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:T
Last Name:HALL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6319 FLY RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9357
Mailing Address - Country:US
Mailing Address - Phone:315-410-6200
Mailing Address - Fax:315-451-2095
Practice Address - Street 1:314 E 1ST ST
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-2927
Practice Address - Country:US
Practice Address - Phone:315-443-9884
Practice Address - Fax:315-410-5554
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY032861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0171OtherMCR GROUP
NYAA0172OtherMCR GROUP