Provider Demographics
NPI:1851870281
Name:MULDER, HANNAH ROSE (DPT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:ROSE
Last Name:MULDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-9071
Mailing Address - Country:US
Mailing Address - Phone:231-463-1891
Mailing Address - Fax:
Practice Address - Street 1:830 COTTAGEVIEW DR STE 204
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2384
Practice Address - Country:US
Practice Address - Phone:231-486-6368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018788261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy