Provider Demographics
NPI:1467486332
Name:HALLORAN, HANNA A (PT)
Entity type:Individual
Prefix:
First Name:HANNA
Middle Name:A
Last Name:HALLORAN
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 1:468 COUNTY HIGHWAY 113
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12134-3749
Mailing Address - Country:US
Mailing Address - Phone:518-848-6505
Mailing Address - Fax:
Practice Address - Street 1:174 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:NY
Practice Address - Zip Code:12134
Practice Address - Country:US
Practice Address - Phone:518-848-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026894225100000X
NY0268941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000412318002OtherBS NENY
6010869OtherMVP
000412318002OtherBS NENY