Provider Demographics
NPI:1497519268
Name:GREENLEE WANNARKA, HANNAH LOUISE (DPT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:LOUISE
Last Name:GREENLEE WANNARKA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:WANNARKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:218 4TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-5720
Mailing Address - Country:US
Mailing Address - Phone:319-200-6102
Mailing Address - Fax:319-200-6104
Practice Address - Street 1:218 4TH AVE SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-5720
Practice Address - Country:US
Practice Address - Phone:319-200-6102
Practice Address - Fax:319-200-6104
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist