Provider Demographics
NPI:1689953002
Name:HERSHER, JOAN ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ELLEN
Last Name:HERSHER
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 1:2777 NE 183RD ST
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2165
Mailing Address - Country:US
Mailing Address - Phone:305-918-0303
Mailing Address - Fax:305-974-0447
Practice Address - Street 1:2777 NE 183RD ST
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-2165
Practice Address - Country:US
Practice Address - Phone:305-918-0303
Practice Address - Fax:305-974-0447
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPT 0005974174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist