Provider Demographics
NPI:1386281392
Name:HIRSCH, JANICE C (PTA)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:C
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:C
Other - Last Name:GAGNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 CORBELING PT
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4657
Mailing Address - Country:US
Mailing Address - Phone:919-376-5773
Mailing Address - Fax:
Practice Address - Street 1:7101 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1682
Practice Address - Country:US
Practice Address - Phone:919-848-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6924225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant