Provider Demographics
NPI:1992932552
Name:HALL, CHAD DERICK (PTA)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:DERICK
Last Name:HALL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:26396 BAY FARM RD
Practice Address - Street 2:BACK BAY PARK CENTER
Practice Address - City:LONG NECK
Practice Address - State:DE
Practice Address - Zip Code:19966-4993
Practice Address - Country:US
Practice Address - Phone:302-947-9662
Practice Address - Fax:302-947-9692
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ2-0000674172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker