Provider Demographics
NPI:1851719793
Name:HANUS, DOMINI REI (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DOMINI
Middle Name:REI
Last Name:HANUS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:DOMINI
Other - Middle Name:REI
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1905 W. HART RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511
Mailing Address - Country:US
Mailing Address - Phone:608-365-7500
Mailing Address - Fax:608-365-0190
Practice Address - Street 1:1905 W. HART RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511
Practice Address - Country:US
Practice Address - Phone:608-365-7500
Practice Address - Fax:608-365-0190
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1526-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1265593503Medicaid
WI100073093Medicaid