Provider Demographics
NPI:1528290715
Name:HALL, SANDRA A (LMT,RMT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:LMT,RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18091 UPPER BAY RD
Mailing Address - Street 2:SUITE 27
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3528
Mailing Address - Country:US
Mailing Address - Phone:281-333-1890
Mailing Address - Fax:281-333-1894
Practice Address - Street 1:18091 UPPER BAY RD
Practice Address - Street 2:SUITE 27
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3537
Practice Address - Country:US
Practice Address - Phone:281-333-1890
Practice Address - Fax:281-333-1894
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT009156225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist