1982618054 NPI number — CHRISTOPHER PAUL HALL ATC, LAT

Table of content: CHRISTOPHER PAUL HALL ATC, LAT (NPI 1982618054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982618054 NPI number — CHRISTOPHER PAUL HALL ATC, LAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
CHRISTOPHER
Provider Middle Name:
PAUL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC, LAT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982618054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4916 PRESTWICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLEYVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76034-4867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-684-0409
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 STADIUM DRIVE- DANIEL MEYER COLISEUM
Provider Second Line Business Practice Location Address:
TCU SPORTS MEDICINE
Provider Business Practice Location Address City Name:
FT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76129-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-257-5399
Provider Business Practice Location Address Fax Number:
817-257-6640
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  AT0776 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AT0776 . This is a "DEPARTMENT OF HEALTH- LAT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 811995 . This is a "NATA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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