Provider Demographics
NPI:1215258389
Name:HALL, STEVEN R (CO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:HALL
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 E SHOW LOW LAKE RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7953
Mailing Address - Country:US
Mailing Address - Phone:928-537-5119
Mailing Address - Fax:
Practice Address - Street 1:2450 E SHOW LOW LAKE RD STE 2B
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7953
Practice Address - Country:US
Practice Address - Phone:928-537-5119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist