Provider Demographics
NPI:1578211066
Name:CLARK, HANNAH R (PT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:R
Last Name:CLARK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:R
Other - Last Name:CHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4425 SWEETBRIAR CT
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-4335
Mailing Address - Country:US
Mailing Address - Phone:650-644-6458
Mailing Address - Fax:
Practice Address - Street 1:2500 GRANT RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4378
Practice Address - Country:US
Practice Address - Phone:650-940-7269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA39114OtherPHYSICALTHERAPY BOARD OF CALIFORNIA