Healthcare Provider Details

I. General information

NPI: 1821318072
Provider Name (Legal Business Name): ABRAHAM R HANCOCK M.S., RKT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17273 STATE ROUTE 104 205
CHILLICOTHEE OH
45601-9718
US

IV. Provider business mailing address

214 W MAIN ST
UTICA MS
39175-9731
US

V. Phone/Fax

Practice location:
  • Phone: 740-773-1141
  • Fax:
Mailing address:
  • Phone: 601-618-0290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: