Provider Demographics
NPI:1386166544
Name:FABRIS, HANNAH (PTA)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:
Last Name:FABRIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:HANNAH
Other - Middle Name:D
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 WELLMORE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9157
Mailing Address - Country:US
Mailing Address - Phone:803-500-1194
Mailing Address - Fax:
Practice Address - Street 1:200 WELLMORE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9157
Practice Address - Country:US
Practice Address - Phone:803-500-1194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3065225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant