Provider Demographics
NPI:1881765261
Name:HANECA, TONY CHRISTOPHER (MED, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:CHRISTOPHER
Last Name:HANECA
Suffix:
Gender:M
Credentials:MED, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3022 34TH ST S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6937
Mailing Address - Country:US
Mailing Address - Phone:218-359-0723
Mailing Address - Fax:
Practice Address - Street 1:1840 15TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3824
Practice Address - Country:US
Practice Address - Phone:701-446-2049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND295-042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer