Individual
DR. MITCHELL MAURICE HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
12722 TONKEL RD STE 102, FORT WAYNE, IN 46845-8201
(260) 739-0300
(260) 818-2299
Mailing address
12722 TONKEL RD STE 102, FORT WAYNE, IN 46845-8201
(260) 739-0300
(260) 818-2299
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
05013055A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05013055A
LICENSE
IN
05
—
300017111
—
IN
Enumeration date
08/02/2018
Last updated
06/25/2020
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