Provider Demographics
NPI:1235485715
Name:HALL, JEREMY ERIC (DPT)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ERIC
Last Name:HALL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LAIDLAW AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1775
Mailing Address - Country:US
Mailing Address - Phone:603-505-0242
Mailing Address - Fax:
Practice Address - Street 1:137 S PEBBLE BEACH BLVD STE 204
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5708
Practice Address - Country:US
Practice Address - Phone:813-530-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
FL26566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist