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NPI Code Detail

MEDICARE: MRS. JEANINE MARY HAKANSON P.T.

MEDICARE: MRS. JEANINE MARY HAKANSON P.T.
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
12251P0200XPediatric Physical Therapist017663NY

General Provider Information

NPI Number : 1932333283
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JEANINE MARY HAKANSON P.T.
Provider Business Mailing Address
First Line : 410 PENDALE ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-4040
Country : US
Telephone Number : 917-609-8094
Fax Number :
Provider Business Practice Location Address
First Line : 410 PENDALE ST
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-4040
Country : US
Telephone Number : 917-609-8094
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2009
Last Update Date : 07/25/2011

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