MEDICARE: MRS. JANICE C HIRSCH 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
1	225200000X	Physical Therapy Assistant	A6924	NC

General Provider Information

NPI Number	:	1386281392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANICE C HIRSCH PTA

Provider Business Mailing Address
First Line	:	1001 CORBELING PT
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4657
Country	:	US
Telephone Number	:	919-376-5773
Fax Number	:

Provider Business Practice Location Address
First Line	:	7101 CREEDMOOR RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1682
Country	:	US
Telephone Number	:	919-848-3333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	12/09/2019

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