Provider Demographics
NPI:1477388122
Name:GITTLI, HANNAH (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:GITTLI
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 WAVELAND CIR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4011 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:SAINT MATTHEWS
Practice Address - State:KY
Practice Address - Zip Code:40207-3122
Practice Address - Country:US
Practice Address - Phone:502-656-8147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT19242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer