Provider Demographics
NPI:1770247421
Name:STAATS, HANNAH PAIGE
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:PAIGE
Last Name:STAATS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 MANDOLIN DR
Mailing Address - Street 2:
Mailing Address - City:SANDYVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25275-9629
Mailing Address - Country:US
Mailing Address - Phone:304-532-8941
Mailing Address - Fax:
Practice Address - Street 1:200 S RITCHIE AVE
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1721
Practice Address - Country:US
Practice Address - Phone:304-273-9385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002798225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant