Provider Demographics
NPI:1518399567
Name:HALL, RYAN DAVID (PT, DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:HALL
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 DEXTER STREET
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160
Mailing Address - Country:US
Mailing Address - Phone:734-439-8410
Mailing Address - Fax:734-439-8430
Practice Address - Street 1:905 DEXTER STREET
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160
Practice Address - Country:US
Practice Address - Phone:734-439-8410
Practice Address - Fax:734-439-8430
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2261236225200000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIL2261236OtherLICENSE