Provider Demographics
NPI:1932758885
Name:GROWE, HANNAH NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:NICOLE
Last Name:GROWE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 VOTIVE PLACE
Mailing Address - Street 2:GLADE SPRINGS RESORT
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832
Mailing Address - Country:US
Mailing Address - Phone:304-673-9733
Mailing Address - Fax:
Practice Address - Street 1:19771 COAL HERITAGE RD
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-9825
Practice Address - Country:US
Practice Address - Phone:681-201-2009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT004192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist