Provider Demographics
NPI:1447458724
Name:HALL, LATONYA MACHELLE (LPTA)
Entity type:Individual
Prefix:
First Name:LATONYA
Middle Name:MACHELLE
Last Name:HALL
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 EMERYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-3705
Mailing Address - Country:US
Mailing Address - Phone:336-617-3032
Mailing Address - Fax:
Practice Address - Street 1:206 GREENSBORO RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-3456
Practice Address - Country:US
Practice Address - Phone:336-886-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3362225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant