Individual
JASON P HANTAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT, CSCS, OCS
Contact information
Practice address
489 WASHINGTON ST, SUITE 200, AUBURN, MA 01501-5709
(508) 721-0000
(508) 721-0100
Mailing address
489 WASHINGTON ST, STE 200, AUBURN, MA 01501-5709
(774) 696-8309
(508) 721-0100
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
16986
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y68375
BLUE CROSS ID
MA
Enumeration date
02/16/2007
Last updated
12/09/2016
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