Healthcare Provider Details

I. General information

NPI: 1760715247
Provider Name (Legal Business Name): SCOTT T HANNIGAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 LEAVITT DR
BRUNWICK ME
04011-5035
US

IV. Provider business mailing address

73 NEWTON RD STE 101
PLAISTOW NH
03865-2424
US

V. Phone/Fax

Practice location:
  • Phone: 207-884-8923
  • Fax:
Mailing address:
  • Phone: 978-388-7272
  • Fax: 978-388-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3856
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: