Provider Demographics
NPI:1942766936
Name:JOB, HANA
Entity Type:Individual
Prefix:
First Name:HANA
Middle Name:
Last Name:JOB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 SOUTHWEST FWY STE 202
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1518
Mailing Address - Country:US
Mailing Address - Phone:832-359-6672
Mailing Address - Fax:832-408-7509
Practice Address - Street 1:9100 SOUTHWEST FWY STE 202
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1518
Practice Address - Country:US
Practice Address - Phone:832-359-6672
Practice Address - Fax:832-408-7509
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10068620225100000X
TX019355225100000X
TX10009938251G00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No251G00000XAgenciesHospice Care, Community BasedGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX834074020Medicaid
TX401013401Medicaid