Provider Demographics
NPI:1346457678
Name:HANNAN, MONA MARIE (MSPT)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:MARIE
Last Name:HANNAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2251
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-2251
Mailing Address - Country:US
Mailing Address - Phone:907-235-4148
Mailing Address - Fax:
Practice Address - Street 1:41385 PTARMIGAN HEIGHTS
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-2251
Practice Address - Country:US
Practice Address - Phone:907-235-4148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist