Provider Demographics
NPI:1174634141
Name:HANNA, INGRID MARIE (MSPT)
Entity Type:Individual
Prefix:MS
First Name:INGRID
Middle Name:MARIE
Last Name:HANNA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:PHYSICAL
Other - Last Name:THERAPY, PLLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:20347 TIMBERLAKE RD STE B
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-7352
Mailing Address - Country:US
Mailing Address - Phone:434-525-4851
Mailing Address - Fax:434-509-1695
Practice Address - Street 1:1111 CORPORATE PARK DR STE B
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2279
Practice Address - Country:US
Practice Address - Phone:434-525-4851
Practice Address - Fax:434-509-1695
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215199225100000X
TX1145688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist