Provider Demographics
NPI:1023118536
Name:HAHN, KATHLEEN MARIE (PT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:HAHN
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 1:541 PINE ACRES BLVD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWATERS
Mailing Address - State:NY
Mailing Address - Zip Code:11718-1219
Mailing Address - Country:US
Mailing Address - Phone:631-665-2773
Mailing Address - Fax:
Practice Address - Street 1:12080 SW HIGHWAY 484
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34432-6408
Practice Address - Country:US
Practice Address - Phone:352-489-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012571-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist