Provider Demographics
NPI:1134207350
Name:HANNAN, RANDI
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:HANNAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1847 HEYDON CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3868
Mailing Address - Country:US
Mailing Address - Phone:702-454-1837
Mailing Address - Fax:
Practice Address - Street 1:601 WHITNEY RANCH DR STE B6
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2643
Practice Address - Country:US
Practice Address - Phone:702-454-1162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV0224OtherLICENSE#