MEDICARE: JENNA HADDAD DPT

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	225100000X	Physical Therapist	8889	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548579220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA HADDAD DPT

Provider Business Mailing Address
First Line	:	345 STEVENS ST
Second Line	:
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-1323
Country	:	US
Telephone Number	:	508-397-8379
Fax Number	:

Provider Business Practice Location Address
First Line	:	253 WASHINGTON ST
Second Line	:
City	:	HUDSON
State	:	MA
Zip	:	01749-2979
Country	:	US
Telephone Number	:	855-657-8723
Fax Number	:

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

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	11/11/2022

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