Basic Information
| Provider Information | |||||||||
| NPI: | 1245837723 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | MARISSA | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4417 CODY BROOK DR | ||||||||
| Address2: | |||||||||
| City: | LIBERTY TWP | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450115475 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139078409 | ||||||||
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| Practice Location | |||||||||
| Address1: | 779 GLENDALE MILFORD RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452151161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137711779 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2020 | ||||||||
| LastUpdateDate: | 10/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | PT018766 | OH | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.