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General NPI Number Information
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NPI Number | 1144183781
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Entity Type | Individual
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Provider Name | DYLAN HANNA PTA
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Gender | Male
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 1717 S RANGE LINE RD
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City | JOPLIN
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State | MO
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Zip | 64804-3234
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Country | US
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Telephone | 417-556-8760
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Fax |
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Provider Business Mailing Address
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Address Line | 225 S HARRISON ST
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City | JASPER
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State | MO
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Zip | 64755-8299
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2020033420
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License Number State | MO
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