Provider Demographics
NPI:1407324205
Name:HIRSCH, JENNA (MAT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 E HIGH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-1629
Mailing Address - Country:US
Mailing Address - Phone:810-404-3432
Mailing Address - Fax:
Practice Address - Street 1:140 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:PA
Practice Address - Zip Code:15940-9734
Practice Address - Country:US
Practice Address - Phone:810-404-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0071252081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine