Provider Demographics
NPI:1972842540
Name:HOEGG, MALLORY JANE
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:JANE
Last Name:HOEGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SAMUELS AVE
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-7316
Mailing Address - Country:US
Mailing Address - Phone:570-926-2045
Mailing Address - Fax:
Practice Address - Street 1:226 SAMUELS AVE
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-7316
Practice Address - Country:US
Practice Address - Phone:570-926-2045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI003494225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant