Provider Demographics
NPI:1669143194
Name:ISBELL, HANNAH (PTA)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:ISBELL
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14087 BOULDER RD
Mailing Address - Street 2:
Mailing Address - City:CARLYLE
Mailing Address - State:IL
Mailing Address - Zip Code:62231-4007
Mailing Address - Country:US
Mailing Address - Phone:618-610-6220
Mailing Address - Fax:
Practice Address - Street 1:111 E ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:NEW BADEN
Practice Address - State:IL
Practice Address - Zip Code:62265-1850
Practice Address - Country:US
Practice Address - Phone:618-588-4924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019040283225200000X
IL160008642225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant