Provider Demographics
NPI:1801104161
Name:SAM, HAHNE WILLIAM (DPT)
Entity type:Individual
Prefix:DR
First Name:HAHNE
Middle Name:WILLIAM
Last Name:SAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 FAIRMOUNT AVE
Mailing Address - Street 2:APT. 1A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-2850
Mailing Address - Country:US
Mailing Address - Phone:408-324-4539
Mailing Address - Fax:
Practice Address - Street 1:431 FAIRMOUNT AVE
Practice Address - Street 2:APT 1A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-2850
Practice Address - Country:US
Practice Address - Phone:408-324-4539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36272225100000X
PAPT020936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist