Provider Demographics
NPI:1841789088
Name:HAHN, GINA (DPT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:HAHN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WESTRA ST
Mailing Address - Street 2:
Mailing Address - City:INTERLAKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4440
Mailing Address - Country:US
Mailing Address - Phone:908-596-9177
Mailing Address - Fax:
Practice Address - Street 1:8840 CYPRESS WATERS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4630
Practice Address - Country:US
Practice Address - Phone:866-752-7934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9050208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation