Healthcare Provider Details

I. General information

NPI: 1588094643
Provider Name (Legal Business Name): DAVID HANNA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2013
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 FACULTY DRIVE SUITE 2
WEST LIBERTY WV
26074-1041
US

IV. Provider business mailing address

208 FACULTY DRIVE SUITE 2
WEST LIBERTY WV
26074-1041
US

V. Phone/Fax

Practice location:
  • Phone: 304-336-7226
  • Fax: 304-218-2299
Mailing address:
  • Phone: 304-336-7226
  • Fax: 304-218-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT002676
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT001120
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: