Healthcare Provider Details

I. General information

NPI: 1740622711
Provider Name (Legal Business Name): HANNAH MAE VIGNERY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH MAE KUENY PT, DPT

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2348 W CENTRAL AVE STE B
EL DORADO KS
67042-3465
US

IV. Provider business mailing address

6397 LEE HWY STE 300
CHATTANOOGA TN
37421-4915
US

V. Phone/Fax

Practice location:
  • Phone: 316-452-5033
  • Fax: 316-452-5053
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-04614
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: