Provider Demographics
NPI:1760604839
Name:HANNON, TRISHA ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:ANN
Last Name:HANNON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:ANN
Other - Last Name:STAINBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:678 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-1653
Practice Address - Country:US
Practice Address - Phone:816-380-3325
Practice Address - Fax:816-380-3044
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03932225100000X
MO2007026350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2868032OtherMEDICARE PTAN
MOMA4370016OtherMEDICARE PTAN
39312066OtherBCBS KC
MOW11F728Medicare PIN
MO39312016OtherBCBS OF KC