Provider Demographics
NPI:1104049972
Name:HIRSH, JODI MICHELLE (MPT)
Entity type:Individual
Prefix:MISS
First Name:JODI
Middle Name:MICHELLE
Last Name:HIRSH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 25TH ST
Mailing Address - Street 2:APT. 7E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-3003
Mailing Address - Country:US
Mailing Address - Phone:212-838-2565
Mailing Address - Fax:
Practice Address - Street 1:201 E 25TH ST
Practice Address - Street 2:APT. 7E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3003
Practice Address - Country:US
Practice Address - Phone:212-838-2565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021565-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist