Provider Demographics
NPI:1144833864
Name:HANNA, GRACE MARIE (DPT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIE
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 1:6804 S KINGS RANCH RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-2960
Mailing Address - Country:US
Mailing Address - Phone:864-350-9688
Mailing Address - Fax:
Practice Address - Street 1:6804 S KINGS RANCH RD STE 103
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-2960
Practice Address - Country:US
Practice Address - Phone:480-983-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist