Healthcare Provider Details

I. General information

NPI: 1023118536
Provider Name (Legal Business Name): KATHLEEN MARIE HAHN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 09/11/2025
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12080 SW HIGHWAY 484
DUNNELLON FL
34432-6408
US

IV. Provider business mailing address

541 PINE ACRES BLVD
BRIGHTWATERS NY
11718-1219
US

V. Phone/Fax

Practice location:
  • Phone: 352-489-9698
  • Fax:
Mailing address:
  • Phone: 631-665-2773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012571-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: