MEDICARE: JENNIFER HAYDN DECAN PTA

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	225200000X	Physical Therapy Assistant	8245	MA

General Provider Information

NPI Number	:	1811325772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HAYDN DECAN PTA

Provider Business Mailing Address
First Line	:	100 NORTH BEACON STREET
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02134
Country	:	US
Telephone Number	:	617-787-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N BEACON ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02134-1928
Country	:	US
Telephone Number	:	617-787-2300
Fax Number	:

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

Provider Enumeration Date	:	10/30/2013
Last Update Date	:	10/30/2013

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