Provider Demographics
NPI:1972531697
Name:HANCOCK, DAVID MAX (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MAX
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1821 N TREKELL RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-1705
Mailing Address - Country:US
Mailing Address - Phone:520-836-3009
Mailing Address - Fax:520-836-4218
Practice Address - Street 1:1821 N TREKELL RD
Practice Address - Street 2:SUITE 8
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-1705
Practice Address - Country:US
Practice Address - Phone:520-836-3009
Practice Address - Fax:520-836-4218
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ2326225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ108208Medicare ID - Type UnspecifiedPHYSICAL PHERAPY PROVIDER