Healthcare Provider Details

I. General information

NPI: 1669732483
Provider Name (Legal Business Name): PAULINE HANNAN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2012
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 S MAIN ST UNIT B
PLEASANT GROVE UT
84062-3528
US

IV. Provider business mailing address

856 S MAIN ST UNIT B
PLEASANT GROVE UT
84062-3528
US

V. Phone/Fax

Practice location:
  • Phone: 509-430-4616
  • Fax:
Mailing address:
  • Phone: 509-430-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number10152248-2401
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2702
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: