Provider Demographics
NPI:1558494997
Name:HANNAH, BRANDY BROOKE (L ,ATC)
Entity Type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:BROOKE
Last Name:HANNAH
Suffix:
Gender:F
Credentials:L ,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-4442
Mailing Address - Country:US
Mailing Address - Phone:813-810-3817
Mailing Address - Fax:
Practice Address - Street 1:4600 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3802
Practice Address - Country:US
Practice Address - Phone:813-810-3817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 13892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer