Provider Demographics
NPI:1659813293
Name:HANNAN, BENJAMIN R (DPT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:R
Last Name:HANNAN
Suffix:
Gender:M
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:PO BOX 643407
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15264-3407
Mailing Address - Country:US
Mailing Address - Phone:800-721-8202
Mailing Address - Fax:800-721-8205
Practice Address - Street 1:35 BILLS BLVD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-3354
Practice Address - Country:US
Practice Address - Phone:765-349-9678
Practice Address - Fax:765-349-9719
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012318A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist