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General NPI Number Information
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NPI Number | 1528080629
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Entity Type | Organization
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Legal Business Name | HANNEKEN PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 286 HOOVER BLVD
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City | HOLLAND
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State | MI
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Zip | 49423-0286
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Country | US
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Telephone | 616-392-2172
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Fax | 616-392-1726
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Provider Business Mailing Address
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Address Line | 286 HOOVER BLVD
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City | HOLLAND
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State | MI
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Zip | 49423-0286
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Country | US
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Telephone | 616-392-2172
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Fax | 616-392-1726
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Authorized Official
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Title or Position | OWNER/PT
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Name | VINCENT HANNEKEN
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Credential | PT
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Telephone | 616-392-2172
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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 | 5501003223
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License Number State | MI
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