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General NPI Number Information
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NPI Number | 1487200838
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Entity Type | Individual
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Provider Name | JOSEPH WILLARD HERSHEY A.T.,C./L
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Gender | Male
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 08/12/2019
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Provider Practice Location Address
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Address Line | 1100 NORTH ST
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City | FREMONT
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State | OH
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Zip | 43420-1132
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Country | US
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Telephone | 419-680-5827
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Fax | 419-334-5450
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Provider Business Mailing Address
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Address Line | 1041 MILLER ST
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City | FREMONT
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State | OH
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Zip | 43420-2122
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Country | US
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Telephone | 419-332-7469
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Fax | 419-334-5450
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | AT-61
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License Number State | OH
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