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General NPI Number Information
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NPI Number | 1205351475
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Entity Type | Individual
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Provider Name | HANNAH LYNN STACKPOOL
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Gender | Female
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Dates
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Enumeration Date | 08/09/2017
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 8811 92ND ST S STE 101
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-4037
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Country | US
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Telephone | 512-413-7776
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Fax |
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Provider Business Mailing Address
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Address Line | 7254 BRITTANY LN
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City | INVER GROVE HEIGHTS
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State | MN
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Zip | 55076-2329
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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