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NPI Code Detail

MEDICARE: MRS. JEAN MARIE HABERMAN PTA

MEDICARE: MRS. JEAN MARIE HABERMAN PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant9125AAZ

General Provider Information

NPI Number : 1184924847
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JEAN MARIE HABERMAN PTA
Provider Business Mailing Address
First Line : 3402 E BROADWAY BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85716-5406
Country : US
Telephone Number : 520-881-0050
Fax Number :
Provider Business Practice Location Address
First Line : 3402 E BROADWAY BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85716-5406
Country : US
Telephone Number : 520-881-0050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2010
Last Update Date : 10/28/2010

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