Provider Demographics
NPI:1134327315
Name:HANNA, HOLLY (DPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HANNA
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 1:72 HOLLY TRL
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-7848
Mailing Address - Country:US
Mailing Address - Phone:601-297-3007
Mailing Address - Fax:
Practice Address - Street 1:6849 PRESTIGE LN
Practice Address - Street 2:SUITE 133
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-2685
Practice Address - Country:US
Practice Address - Phone:601-297-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6599616-2401225100000X
GAPT011831225100000X
TN10393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist