Provider Demographics
NPI:1619340353
Name:TIEP, HANNA LE (DPT)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:LE
Last Name:TIEP
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 1:307 MESQUAKI DR
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-9778
Mailing Address - Country:US
Mailing Address - Phone:601-291-3803
Mailing Address - Fax:
Practice Address - Street 1:307 MESQUAKI DR
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-9778
Practice Address - Country:US
Practice Address - Phone:601-291-3803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist