Basic Information
| Provider Information | |||||||||
| NPI: | 1346215951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEDGER | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LAT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 732 S WESTVIEW CIR | ||||||||
| Address2: | |||||||||
| City: | ANDOVER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670029336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167337352 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1923 N WEBB RD | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672063405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162624886 | ||||||||
| FaxNumber: | 3162624887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2006 | ||||||||
| LastUpdateDate: | 06/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 24-0041 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.