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General NPI Number Information
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NPI Number | 1043888761
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Entity Type | Individual
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Provider Name | JASON HARDIN
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Gender | Male
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 5905 SEVERIN DR
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City | LA MESA
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State | CA
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Zip | 91942-3806
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Country | US
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Telephone | 619-589-2606
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Fax |
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Provider Business Mailing Address
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Address Line | 1623 MILLS ST
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City | CHULA VISTA
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State | CA
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Zip | 91913-2016
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Country | US
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Telephone | 619-565-4285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 297750
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License Number State | CA
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