Provider Demographics
NPI:1104533280
Name:GORES, HANNAH RENEE (PTA)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:RENEE
Last Name:GORES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:RENEE
Other - Last Name:ZISCHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:243 E 3RD PL
Mailing Address - Street 2:
Mailing Address - City:BYERS
Mailing Address - State:CO
Mailing Address - Zip Code:80103-9755
Mailing Address - Country:US
Mailing Address - Phone:937-631-3927
Mailing Address - Fax:
Practice Address - Street 1:243 E 3RD PL
Practice Address - Street 2:
Practice Address - City:BYERS
Practice Address - State:CO
Practice Address - Zip Code:80103-9755
Practice Address - Country:US
Practice Address - Phone:937-631-3927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0015260225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant