Provider Demographics
NPI:1841707551
Name:HANRAHAN, ADAM T
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:T
Last Name:HANRAHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 JOHN ROBERTS RD STE 16
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6983
Mailing Address - Country:US
Mailing Address - Phone:207-347-3030
Mailing Address - Fax:207-536-4449
Practice Address - Street 1:125 JOHN ROBERTS RD STE 16
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6983
Practice Address - Country:US
Practice Address - Phone:207-347-3030
Practice Address - Fax:207-536-4449
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT4332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer