Provider Demographics
NPI:1730240086
Name:HALL, RICH ELWOOD (ATC)
Entity type:Individual
Prefix:MR
First Name:RICH
Middle Name:ELWOOD
Last Name:HALL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 N 1600 W
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:UT
Mailing Address - Zip Code:84320-1648
Mailing Address - Country:US
Mailing Address - Phone:435-716-2884
Mailing Address - Fax:
Practice Address - Street 1:1300 N 500 E
Practice Address - Street 2:SUITE 120
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2408
Practice Address - Country:US
Practice Address - Phone:435-716-2882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6289571-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer