Healthcare Provider Details

I. General information

NPI: 1558544924
Provider Name (Legal Business Name): WILLIAM JAMES HANNEY IV P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2007
Last Update Date: 12/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WOODBURY RD SUITE 103
ORLANDO FL
32828-4514
US

IV. Provider business mailing address

801 WOODBURY RD SUITE 103
ORLANDO FL
32828-4514
US

V. Phone/Fax

Practice location:
  • Phone: 407-373-6082
  • Fax: 407-373-6083
Mailing address:
  • Phone: 407-373-6082
  • Fax: 407-373-6083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT18334
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: