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General NPI Number Information
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NPI Number | 1710449210
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Entity Type | Individual
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Provider Name | RAYMOND SCOTT HANAN PTA
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Gender | Male
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Dates
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Enumeration Date | 04/03/2019
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Last Update Date | 04/03/2019
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Provider Practice Location Address
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Address Line | 6263 N GREEN BAY AVE
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City | MILWAUKEE
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State | WI
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Zip | 53209-3823
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Country | US
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Telephone | 414-451-0543
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 250TH ST SPC 45
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City | LOMITA
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State | CA
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Zip | 90717-3815
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Country | US
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Telephone | 310-626-3332
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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 | 49888
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License Number State | CA
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