Healthcare Provider Details

I. General information

NPI: 1912921933
Provider Name (Legal Business Name): VINCENT J HANNEKEN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 HOOVER BLVD
HOLLAND MI
49423-0286
US

IV. Provider business mailing address

286 HOOVER BLVD
HOLLAND MI
49423-0286
US

V. Phone/Fax

Practice location:
  • Phone: 616-392-2172
  • Fax: 616-392-1726
Mailing address:
  • Phone: 616-392-2172
  • Fax: 616-392-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501003223
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: