Provider Demographics
NPI:1306110242
Name:HALL, EMILY ANNE (ATC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:HALL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 S CLARIZZ BLVD APT 275
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4297
Mailing Address - Country:US
Mailing Address - Phone:484-894-5940
Mailing Address - Fax:
Practice Address - Street 1:2805 E 10TH ST
Practice Address - Street 2:UNIVERSITY GYMNASIUM
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-2619
Practice Address - Country:US
Practice Address - Phone:484-894-5940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001710A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer