Provider Demographics
NPI:1649381377
Name:HANLON, KATHLEEN MARY (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY
Last Name:HANLON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PALOMINO LN
Mailing Address - Street 2:STE 401
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6447
Mailing Address - Country:US
Mailing Address - Phone:603-669-7716
Mailing Address - Fax:603-669-0103
Practice Address - Street 1:80 PALOMINO LN
Practice Address - Street 2:STE 401
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6447
Practice Address - Country:US
Practice Address - Phone:603-669-7716
Practice Address - Fax:603-669-0103
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30003217OtherMEDICAID ID
NH597569OtherAETNA ID
NH54200OtherCIGNA ID
NHAA17751OtherHARVARD ID
NHAA17751OtherHARVARD ID
NH54200OtherCIGNA ID