Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1116267 | TX |
N | 2251G0304X | Physical Therapist - Geriatrics | 1116267 | TX |
N | 2251N0400X | Physical Therapist - Neurology | 1116267 | TX |
N | 2251P0200X | Physical Therapist - Pediatrics | 1116267 | TX |
N | 2251S0007X | Physical Therapist - Sports | 1116267 | TX |
N | 2251X0800X | Physical Therapist - Orthopedic | 1116267 | TX |
NPI | 1124281811 |
---|---|
Provider Name | Jennifer Danielle Hataway |
First Address | Pampa, TX 79065-5126 |
Second Address | Pampa, TX 79065-5126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2008 |
Last Update Date | 05/12/2012 |