Provider Demographics
NPI:1407038425
Name:HAAG, JESSICA LYNN (PT)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LYNN
Last Name:HAAG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 E PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9213
Mailing Address - Country:US
Mailing Address - Phone:717-840-1874
Mailing Address - Fax:717-840-0968
Practice Address - Street 1:2821 E PROSPECT RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-9213
Practice Address - Country:US
Practice Address - Phone:717-840-1874
Practice Address - Fax:717-840-0968
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA18444OtherHEALTH AMERICA
PA0068377000OtherAMERIHEALTH UNDER IBC
PA177124OtherHGSA PROVIDER NUMBER
PA332313OtherHIGHMARK BLUE SHIELD
PA03182100OtherCAPITAL BLUE CROSS
PACK4276OtherPALMETTO GBA RR MEDICARE
PA177124OtherHGSA PROVIDER NUMBER