Provider Demographics
NPI:1588243349
Name:HALL, JILL LENORE (LMT)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:LENORE
Last Name:HALL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 JACKRABBIT LN STE 4
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-8967
Mailing Address - Country:US
Mailing Address - Phone:406-589-4291
Mailing Address - Fax:
Practice Address - Street 1:6300 JACKRABBIT LN STE 4
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-8967
Practice Address - Country:US
Practice Address - Phone:406-589-4291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-13910225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist