Provider Demographics
NPI:1639295991
Name:HASTINGS, JACQULINE SUZANNE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JACQULINE
Middle Name:SUZANNE
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:JACQULINE
Other - Middle Name:SUZANNE
Other - Last Name:TYMRAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:744 S WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3505
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:901 S LINCOLN RD
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-3174
Practice Address - Country:US
Practice Address - Phone:906-789-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1689225100000X
MI5501011459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist