Provider Demographics
NPI:1275581530
Name:HANNA, GARY ROBERT (ATC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ROBERT
Last Name:HANNA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-1320
Mailing Address - Country:US
Mailing Address - Phone:724-588-6636
Mailing Address - Fax:
Practice Address - Street 1:MCCOMB FIELDHOUSE
Practice Address - Street 2:EDINBORO UNIVERSITY
Practice Address - City:EDINBORO
Practice Address - State:PA
Practice Address - Zip Code:16444-0001
Practice Address - Country:US
Practice Address - Phone:814-732-2776
Practice Address - Fax:814-732-2857
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000255A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer