Healthcare Provider Details

I. General information

NPI: 1801773767
Provider Name (Legal Business Name): JOHN NASSEF HANNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 S BARRANCA AVE STE 555
COVINA CA
91723-2791
US

IV. Provider business mailing address

902 E BENNETT AVE
GLENDORA CA
91741-2863
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-2273
  • Fax: 818-357-2505
Mailing address:
  • Phone: 877-757-8353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number308414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: