Provider Demographics
NPI:1164580361
Name:HANNIGAN, ALEXIS (PT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:HANNIGAN
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 1:192 TILLEY DR
Mailing Address - Street 2:OSC - REHAB THERAPIES
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4440
Mailing Address - Country:US
Mailing Address - Phone:802-847-7003
Mailing Address - Fax:802-847-6987
Practice Address - Street 1:192 TILLEY DR
Practice Address - Street 2:OSC - REHAB THERAPIES
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-4440
Practice Address - Country:US
Practice Address - Phone:802-847-7003
Practice Address - Fax:802-847-6987
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013020Medicaid