Provider Demographics
NPI:1588094643
Name:HANNA, DAVID (DPT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:HANNA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 FACULTY DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST LIBERTY
Mailing Address - State:WV
Mailing Address - Zip Code:26074-1041
Mailing Address - Country:US
Mailing Address - Phone:304-336-7226
Mailing Address - Fax:304-218-2299
Practice Address - Street 1:208 FACULTY DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST LIBERTY
Practice Address - State:WV
Practice Address - Zip Code:26074-1041
Practice Address - Country:US
Practice Address - Phone:304-336-7226
Practice Address - Fax:304-218-2299
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT002676225100000X
WVAT0011202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist