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1790306884
KEVIN WILLIS HALL
LOGAN, UT
NPI
1790306884
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2081S0010X Physical Medicine & Rehabilitation Sports Medicine
(Licence: UT 9037678-2402)
Enumeration Date
2020-04-30
Last Update Date
2020-04-30
Business Address
KEVIN WILLIS HALL PTA
1400 N 500 E
LOGAN, UT 84341-2455
Phone number: 435-716-2882
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Mailing Address
KEVIN WILLIS HALL PTA
1510 W CENTER ST
LEWISTON, UT 84320-1645
Phone number: 435-770-8798
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