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General NPI Number Information
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NPI Number | 1669535563
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Entity Type | Individual
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Provider Name | BRYAN D HATHAWAY PT
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 115 HICKORIES PARK RD
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City | OWEGO
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State | NY
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Zip | 13827-4845
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Country | US
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Telephone | 607-687-7645
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Fax | 607-687-7646
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Provider Business Mailing Address
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Address Line | 115 HICKORIES PARK ROAD
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City | OWEGO
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State | NY
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Zip | 13827
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Country | US
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Telephone | 607-687-7645
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Fax | 607-687-7646
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0116511
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License Number State | NY
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