Provider Demographics
NPI:1891757175
Name:HANNLEY, BRYAN M (PT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:M
Last Name:HANNLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 N CAMPBELL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-7305
Mailing Address - Country:US
Mailing Address - Phone:520-797-7246
Mailing Address - Fax:866-281-9515
Practice Address - Street 1:3100 N CAMPBELL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-7305
Practice Address - Country:US
Practice Address - Phone:520-797-7246
Practice Address - Fax:866-281-9515
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ914201Medicaid