Provider Demographics
NPI:1164941399
Name:HOCH, JADA RAE (PTA)
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:RAE
Last Name:HOCH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JADA
Other - Middle Name:RAE
Other - Last Name:HILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:528 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HALSTEAD
Mailing Address - State:KS
Mailing Address - Zip Code:67056
Mailing Address - Country:US
Mailing Address - Phone:316-259-1559
Mailing Address - Fax:
Practice Address - Street 1:600 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114
Practice Address - Country:US
Practice Address - Phone:316-283-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01904225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant