Provider Demographics
NPI:1750575486
Name:HANNA, SAMIR (PHD PT)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:HANNA
Suffix:
Gender:M
Credentials:PHD PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 ASTER DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3871
Mailing Address - Country:US
Mailing Address - Phone:248-650-1984
Mailing Address - Fax:248-650-1994
Practice Address - Street 1:1050 W UNIVERSITY DR STE 3
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1877
Practice Address - Country:US
Practice Address - Phone:248-650-1984
Practice Address - Fax:248-650-1994
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5507005736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM99480001Medicare PIN