Provider Demographics
NPI:1104056837
Name:HANIGAN, KELLEE LYNN (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:KELLEE
Middle Name:LYNN
Last Name:HANIGAN
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 1:615 N. NASH STREET
Mailing Address - Street 2:SUITE 306
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245
Mailing Address - Country:US
Mailing Address - Phone:310-535-0008
Mailing Address - Fax:310-535-0009
Practice Address - Street 1:615 N. NASH STREET
Practice Address - Street 2:SUITE 306
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245
Practice Address - Country:US
Practice Address - Phone:310-535-0008
Practice Address - Fax:310-535-0009
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35797225100000X
NE2966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist