Provider Demographics
NPI:1073239570
Name:VACA, HANNAH MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:MARIE
Last Name:VACA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 N SPLITROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-1529
Mailing Address - Country:US
Mailing Address - Phone:605-582-3908
Mailing Address - Fax:
Practice Address - Street 1:103 N SPLITROCK BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-1529
Practice Address - Country:US
Practice Address - Phone:605-582-3908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist