Provider Demographics
NPI:1477165108
Name:HUERTA, HANNAH (PT,DPT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:HUERTA
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:PIGNATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:688 WILDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MAHTOMEDI
Mailing Address - State:MN
Mailing Address - Zip Code:55115-1812
Mailing Address - Country:US
Mailing Address - Phone:651-429-9947
Mailing Address - Fax:
Practice Address - Street 1:500 CARLSON PKWY
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5304
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:877-407-4329
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1477165108Medicaid