Basic Information
| Provider Information | |||||||||
| NPI: | 1881233781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WAUGAMAN | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | RT. 9W | ||||||||
| Address2: | |||||||||
| City: | WEST HAVERSTRAW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457864000 | ||||||||
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| Practice Location | |||||||||
| Address1: | RT. 9W | ||||||||
| Address2: | |||||||||
| City: | WEST HAVERSTRAW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457864000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2019 | ||||||||
| LastUpdateDate: | 12/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/26/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251N0400X | 029192-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology |
No ID Information.