MEDICARE: MR. HERBERT MAYNARD HESS PHYSICAL THERAPIST

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	174400000X	Specialist	8536	NC
2	225100000X	Physical Therapist	002799	GA

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	:	1740285873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HERBERT MAYNARD HESS PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	620 JL WHITE DRIVE
Second Line	:	SUITE 110
City	:	JASPER
State	:	GA
Zip	:	30143
Country	:	US
Telephone Number	:	706-692-9080
Fax Number	:	706-692-1199

Provider Business Practice Location Address
First Line	:	620 JL WHITE DRIVE
Second Line	:	SUITE 110
City	:	JASPER
State	:	GA
Zip	:	30143
Country	:	US
Telephone Number	:	706-692-9080
Fax Number	:	706-692-1199

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	10/18/2013

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