Provider Demographics
NPI:1063467579
Name:JASEN, HECTOR (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:JASEN
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FOXFIRE BND
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1026
Mailing Address - Country:US
Mailing Address - Phone:518-877-4970
Mailing Address - Fax:
Practice Address - Street 1:13 FOXFIRE BND
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-1026
Practice Address - Country:US
Practice Address - Phone:518-877-4970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235184755OtherGROUP NPI
1235184755OtherGROUP NPI