Mitchell Maurice Hall, PT, DPT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

05013055A Issued in IN

Practice address

12722 Tonkel Rd Ste 102
Fort Wayne, IN 46845-8201

Phone

(260) 739-0300

Fax

(260) 818-2299

NPI assigned

Aug 2, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593043200000",
    "number": "1295213114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12722 TONKEL RD STE 102",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468458201",
            "telephone_number": "260-739-0300",
            "fax_number": "260-818-2299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12722 TONKEL RD STE 102",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468458201",
            "telephone_number": "260-739-0300",
            "fax_number": "260-818-2299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "MITCHELL",
        "middle_name": "MAURICE",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-02",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IN",
            "license": "05013055A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300017111",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "05013055A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mitchell@protailored.com",
            "affiliation": "N",
            "address_1": "12722 Tonkel Rd Ste 102",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468458201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Janica Hall
• Kerri George Hall, MD
• Leah Ellen Hall, MA
• Leann Hall
• Melissa Nicole Hall, LSW
• Monica Jane Hall
• Nichole Hall
• Ronald R Hall, M.D.
• Sean Hall, LMHC
• Shana R Hall, RBT

• Orthopedic Physical Therapist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Orthopedic Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.