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General NPI Number Information
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NPI Number | 1649393844
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Entity Type | Individual
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Provider Name | DEREK HANAMAN MPT
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Gender | Male
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 02/23/2017
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Provider Practice Location Address
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Address Line | 36500 AURORA DR
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City | SUMMIT
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State | WI
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Zip | 53066-4899
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Country | US
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Telephone | 262-434-2606
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Fax |
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Provider Business Mailing Address
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Address Line | 352 STILL WATER CT
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City | DOUSMAN
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State | WI
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Zip | 53118-8832
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Country | US
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Telephone | 414-406-1664
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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 | 6317-024
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License Number State | WI
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