Provider Demographics
NPI:1366082430
Name:HALL, SAMANTHA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9777 S YOSEMITE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-3115
Mailing Address - Country:US
Mailing Address - Phone:720-560-3083
Mailing Address - Fax:877-613-8072
Practice Address - Street 1:9777 S YOSEMITE ST STE 110
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-3115
Practice Address - Country:US
Practice Address - Phone:720-560-3083
Practice Address - Fax:877-613-8072
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0016282225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist