Provider Demographics
NPI:1134675879
Name:MUNDY, HANNA RAE (ATC, BCS-O, OTC)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:RAE
Last Name:MUNDY
Suffix:
Gender:F
Credentials:ATC, BCS-O, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 AMESBURY DR APT 2306
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-0021
Mailing Address - Country:US
Mailing Address - Phone:214-236-5210
Mailing Address - Fax:
Practice Address - Street 1:7115 GREENVILLE AVE STE 310
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5103
Practice Address - Country:US
Practice Address - Phone:214-265-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT65842255A2300X
3000100020246ZX2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant