Provider Demographics
NPI:1508598285
Name:BRUNSON, HANNAH ALEXIS (DPT,PT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:ALEXIS
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:DPT,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 GARLAND ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48214-3124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:79-7422 MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750-7913
Practice Address - Country:US
Practice Address - Phone:808-322-8400
Practice Address - Fax:808-322-5167
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-5409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist