Provider Demographics
NPI:1043985195
Name:HANNAH, ALEX (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:HANNAH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 MILLSOP DR
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-2956
Mailing Address - Country:US
Mailing Address - Phone:304-374-7342
Mailing Address - Fax:
Practice Address - Street 1:3690 W WHEATLAND RD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3462
Practice Address - Country:US
Practice Address - Phone:972-296-6645
Practice Address - Fax:972-296-4526
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT004429225100000X
TXCP007778T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist