Healthcare Provider Details

I. General information

NPI: 1396083960
Provider Name (Legal Business Name): DEBRA J. HANAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 NE 28TH ST
VANCOUVER WA
98682-8091
US

IV. Provider business mailing address

13501 NE 28TH ST
VANCOUVER WA
98682-8091
US

V. Phone/Fax

Practice location:
  • Phone: 360-604-6700
  • Fax:
Mailing address:
  • Phone: 360-604-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT00001072
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: