Individual
MS. MARY LISA HALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
2500 MARSHALL AVE, PAUCAH, KY 42003
(270) 554-3135
(270) 554-3136
Mailing address
245 JENNIFER LYNN DR, PADUCAH, KY 42001
(270) 705-5898
(270) 554-3136
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002256
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11856022
CAQH
—
05
—
7100041860
—
KY
01
—
P00417118
MEDICARE RAILROAD
KY
Enumeration date
08/12/2006
Last updated
04/27/2018
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