Provider Demographics
NPI:1063189785
Name:HANNIGAN-LUTHER, SHAY (ATC)
Entity type:Individual
Prefix:
First Name:SHAY
Middle Name:
Last Name:HANNIGAN-LUTHER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 E BANCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3926
Mailing Address - Country:US
Mailing Address - Phone:208-771-3541
Mailing Address - Fax:
Practice Address - Street 1:WASHINGTON STATE UNIVERSITY ATHLETICS
Practice Address - Street 2:BOHLER ATHLETIC COMPLEX M4
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163
Practice Address - Country:US
Practice Address - Phone:208-771-3541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAA1612013932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer