Provider Demographics
NPI:1346215951
Name:HEDGER, JAY M (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:M
Last Name:HEDGER
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 S WESTVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-9336
Mailing Address - Country:US
Mailing Address - Phone:316-733-7352
Mailing Address - Fax:
Practice Address - Street 1:1923 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3405
Practice Address - Country:US
Practice Address - Phone:316-262-4886
Practice Address - Fax:316-262-4887
Is Sole Proprietor?:No
Enumeration Date:2006-02-18
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-00412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer