Provider Demographics
NPI:1255696217
Name:HANLON, DAMIAN MARTIN (PT)
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:MARTIN
Last Name:HANLON
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 1:26315 N 57TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-1238
Mailing Address - Country:US
Mailing Address - Phone:602-327-8870
Mailing Address - Fax:623-455-3451
Practice Address - Street 1:26315 N 57TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-1238
Practice Address - Country:US
Practice Address - Phone:602-327-8870
Practice Address - Fax:623-455-3451
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist