Healthcare Provider Details

I. General information

NPI: 1023416989
Provider Name (Legal Business Name): MATTHEW HANNAN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WOODRUFF INDUSTRIAL LN
GREENVILLE SC
29607-4101
US

IV. Provider business mailing address

101 WOODRUFF INDUSTRIAL LN
GREENVILLE SC
29607-4101
US

V. Phone/Fax

Practice location:
  • Phone: 864-735-0593
  • Fax:
Mailing address:
  • Phone: 864-735-0593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT024126
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number25287
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number9727
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: