Provider Demographics
NPI:1417612284
Name:WADE, HANNAH RENEE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:RENEE
Last Name:WADE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:RENEE
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:52 STATION BRANCH EST
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-2108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:843 EASTERN BYP STE 3
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2569
Practice Address - Country:US
Practice Address - Phone:859-544-1770
Practice Address - Fax:859-310-7191
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1354657225100000X
KY008503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist