Provider Demographics
NPI:1508364597
Name:HANNA, TIMOTHY (ATC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
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 1:2309 ARQUILLA DR
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-4255
Mailing Address - Country:US
Mailing Address - Phone:317-979-4231
Mailing Address - Fax:
Practice Address - Street 1:150 N MICHIGAN AVE STE 1400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7568
Practice Address - Country:US
Practice Address - Phone:312-444-1145
Practice Address - Fax:312-444-1145
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960033762255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer