Provider Demographics
NPI:1114984325
Name:HANKS, ANNE V (PT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:V
Last Name:HANKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:303-546-9158
Mailing Address - Fax:303-546-9107
Practice Address - Street 1:2346 BROADWAY ST
Practice Address - Street 2:STE 1
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4107
Practice Address - Country:US
Practice Address - Phone:303-444-4145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2421174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COMO20263OtherBCBS
COC15683Medicare PIN