Provider Demographics
NPI:1851855431
Name:KEARNEY, HANNA (PT)
Entity Type:Individual
Prefix:
First Name:HANNA
Middle Name:
Last Name:KEARNEY
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 1:364 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6148
Mailing Address - Country:US
Mailing Address - Phone:315-326-0056
Mailing Address - Fax:315-326-0102
Practice Address - Street 1:20053 SUMMIT VIEW BLVD STE 2
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-681-4187
Practice Address - Fax:315-661-6068
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041789-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5609201Medicaid