1164891081 NPI number — JEFFREY ALAN HUTTON M.S., ATC ,CSCS, PES

Table of content: JENNIFER JESHURUN DPT (NPI 1043739758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164891081 NPI number — JEFFREY ALAN HUTTON M.S., ATC ,CSCS, PES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUTTON
Provider First Name:
JEFFREY
Provider Middle Name:
ALAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., ATC ,CSCS, PES
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164891081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 LIGHTHOUSE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17038-8953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-558-9146
Provider Business Mailing Address Fax Number:
717-884-7151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 LIGHTHOUSE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17038-8953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-558-9146
Provider Business Practice Location Address Fax Number:
717-884-7151
Provider Enumeration Date:
09/21/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  RT004228 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com