Provider Demographics
NPI:1609437102
Name:MAUS, HANNAH LAUREN (DPT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:LAUREN
Last Name:MAUS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 W BUTTE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7525
Mailing Address - Country:US
Mailing Address - Phone:208-360-9825
Mailing Address - Fax:
Practice Address - Street 1:520 S EAGLE RD STE 2106
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6363
Practice Address - Country:US
Practice Address - Phone:208-706-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-6284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist