Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 008581-1 | NY |
NPI | 1003155839 |
---|---|
Provider Name | Mrs. Jerrica Rose Hager |
First Address | Batavia, NY 14020-9422 |
Second Address | Williamsville, NY 14221-5477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2013 |
Last Update Date | 14/02/2013 |