Provider Demographics
NPI:1619084860
Name:HAHN, JEFFREY WILLIS (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WILLIS
Last Name:HAHN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 MEDICAL PARK DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2105
Mailing Address - Country:US
Mailing Address - Phone:228-396-3374
Mailing Address - Fax:228-396-3379
Practice Address - Street 1:1721 MEDICAL PARK DR
Practice Address - Street 2:STE 102
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2109
Practice Address - Country:US
Practice Address - Phone:228-396-3374
Practice Address - Fax:228-396-3379
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT2619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00124051Medicaid