Healthcare Provider Details

I. General information

NPI: 1336436633
Provider Name (Legal Business Name): PATRICIA I JUNG P.T., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 NORTHAMPTON ST EASTHAMPTON HEALTH CENTER
EASTHAMPTON MA
01027-1046
US

IV. Provider business mailing address

PO BOX 8019
SPRINGFIELD MA
01102-8000
US

V. Phone/Fax

Practice location:
  • Phone: 413-282-3853
  • Fax: 413-282-3881
Mailing address:
  • Phone: 866-431-4077
  • Fax: 413-774-7448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7306
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: