Provider Demographics
NPI:1487200838
Name:HERSHEY, JOSEPH WILLARD (AT,C/L)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WILLARD
Last Name:HERSHEY
Suffix:
Gender:M
Credentials:AT,C/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2122
Mailing Address - Country:US
Mailing Address - Phone:419-332-7469
Mailing Address - Fax:419-334-5450
Practice Address - Street 1:1100 NORTH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-1132
Practice Address - Country:US
Practice Address - Phone:419-680-5827
Practice Address - Fax:419-334-5450
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-612081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine