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General NPI Number Information
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NPI Number | 1619579661
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Entity Type | Individual
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Provider Name | JESSICA HAINSWORTH PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 07/09/2023
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Provider Practice Location Address
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Address Line | 4440 RIDGE RD
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City | WILLIAMSON
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State | NY
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Zip | 14589-9382
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Country | US
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Telephone | 315-589-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 6029 LOGAN RD
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City | MOUNT MORRIS
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State | NY
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Zip | 14510-9718
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Country | US
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Telephone | 585-802-1471
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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 | PT5775
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 046364
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License Number State | NY
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