Provider Demographics
NPI:1992742985
Name:HALLS, RUTH ANN (PT)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:HALLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-6800
Mailing Address - Fax:701-364-6828
Practice Address - Street 1:801 BELSLY BLVD
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5055
Practice Address - Country:US
Practice Address - Phone:701-364-6800
Practice Address - Fax:701-364-6828
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND852225100000X
MN2156225100000X
MI5501008624225100000X
MN7655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1992742985Medicaid
MN1992742985Medicaid