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Individual

MR. GARY RUSSELL HALES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
1514 CARDINAL RD, BOWLING GREEN, OH 43402-8821
(435) 724-0475
Mailing address
1514 CARDINAL RD, BOWLING GREEN, OH 43402-8821

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
07005
OH

Other

Enumeration date
08/24/2009
Last updated
08/24/2009
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