Active NPI
Chad Derick Hall, PTA
- Community Health Worker
- Long Neck, DE
National Provider Identifier
1992932552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- J2-0000674
- Practice address
- 26396 Bay Farm Rd
Back Bay Park Center
Long Neck, DE 19966-4993 - Phone
- (302) 947-9662
- Fax
- (302) 947-9692
- NPI assigned
- Jun 22, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | J2-0000674 | DE | Primary |
Addresses
Primary practice location
26396 Bay Farm Rd
Back Bay Park Center
Long Neck, DE 19966-4993
Mailing address
2 W 10TH St
Marcus Hook, PA 19061-4513
Phone (610) 859-8850
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| J2-0000674 | DE | MD | Community Health Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dynamic Therapy Services of Pennsylvania LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Aston, PA
- NPI 1346477981
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254096000000",
"number": "1992932552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 W 10TH ST",
"city": "MARCUS HOOK",
"state": "PA",
"postal_code": "190614513",
"telephone_number": "610-859-8850",
"fax_number": "610-859-7876"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26396 BAY FARM RD",
"address_2": "BACK BAY PARK CENTER",
"city": "LONG NECK",
"state": "DE",
"postal_code": "199664993",
"telephone_number": "302-947-9662",
"fax_number": "302-947-9692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALL",
"first_name": "CHAD",
"middle_name": "DERICK",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-22",
"last_updated": "2009-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "DE",
"license": "J2-0000674",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Neck, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.