Basic Information
Provider Information
NPI: 1821559501
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOAK
FirstName: JESSE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 118 NATURE PARK RD
Address2:  
City: GREENSBURG
State: PA
PostalCode: 156016960
CountryCode: US
TelephoneNumber: 7246890571
FaxNumber: 7246890560
Practice Location
Address1: 118 NATURE PARK RD
Address2:  
City: GREENSBURG
State: PA
PostalCode: 156016960
CountryCode: US
TelephoneNumber: 7246890571
FaxNumber: 7246890560
Other Information
ProviderEnumerationDate: 03/26/2019
LastUpdateDate: 10/06/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT027490PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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