Provider Demographics
NPI:1124899349
Name:WILSON, HANNAH MARIE (DPT)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17405 POND VIEW PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-5303
Mailing Address - Country:US
Mailing Address - Phone:937-751-0625
Mailing Address - Fax:
Practice Address - Street 1:695 S COLORADO BLVD STE 20
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-8010
Practice Address - Country:US
Practice Address - Phone:303-360-0727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0019648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist