Provider Demographics
NPI:1073667960
Name:LEE, HANNA HAE HEUNG (PT)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:HAE HEUNG
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6715 MAPLE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-4542
Mailing Address - Country:US
Mailing Address - Phone:847-858-1190
Mailing Address - Fax:
Practice Address - Street 1:1747 N RURAL ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-4425
Practice Address - Country:US
Practice Address - Phone:317-635-1355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
IL070015395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist