Provider Demographics
NPI:1285396382
Name:PROEFROCK, HANNAH LYNN CHRISTINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:LYNN CHRISTINE
Last Name:PROEFROCK
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 1:1103 E BOXELDER RD STE U
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5582
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:902 E 3RD ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4023
Practice Address - Country:US
Practice Address - Phone:307-756-9200
Practice Address - Fax:307-756-9203
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist