Provider Demographics
NPI:1063187391
Name:SAGAN, HANNAH GRACE SKADOW (PT)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:GRACE SKADOW
Last Name:SAGAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3767 BANCROFT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3857
Mailing Address - Country:US
Mailing Address - Phone:303-501-4626
Mailing Address - Fax:
Practice Address - Street 1:2999 MISSION BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-8028
Practice Address - Country:US
Practice Address - Phone:858-216-4443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist