Provider Demographics
NPI:1538410980
Name:HALL, ALICIA (MS, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 GOLDEN EAGLE CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-4899
Mailing Address - Country:US
Mailing Address - Phone:989-430-7897
Mailing Address - Fax:
Practice Address - Street 1:1100 GOLDEN EAGLE CIR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-4899
Practice Address - Country:US
Practice Address - Phone:989-430-7897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 32772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer