Provider Demographics
NPI:1386792810
Name:HANNIBAL, GUY CHRISTOPHER (PT)
Entity type:Individual
Prefix:MR
First Name:GUY
Middle Name:CHRISTOPHER
Last Name:HANNIBAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6890
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47719-0890
Mailing Address - Country:US
Mailing Address - Phone:812-491-3856
Mailing Address - Fax:
Practice Address - Street 1:111 COLONY CROSSING WAY STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6873
Practice Address - Country:US
Practice Address - Phone:601-203-3869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08501240Medicaid