Provider Demographics
NPI:1508445446
Name:CARMEN, HANNAH (PT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:CARMEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4896 S BRIGHT ANGEL TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-8369
Mailing Address - Country:US
Mailing Address - Phone:928-899-5837
Mailing Address - Fax:
Practice Address - Street 1:12400 HIGH BLUFF DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3077
Practice Address - Country:US
Practice Address - Phone:858-792-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK160063225100000X
AZLPT-013031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPT-013031OtherARIZONA STATE BOARD OF PHYSICAL THERAPY
AK160063OtherSTATE PHYSICAL AND OCCUPATIONAL THERAPY BOARD