Provider Demographics
NPI:1508411414
Name:KING, HANNAH MARTELL
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARTELL
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4161 KING RICHARD DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2522
Mailing Address - Country:US
Mailing Address - Phone:941-773-6080
Mailing Address - Fax:
Practice Address - Street 1:5147 OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:SIESTA KEY
Practice Address - State:FL
Practice Address - Zip Code:34242-1674
Practice Address - Country:US
Practice Address - Phone:941-870-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist