MEDICARE: HANNAH SUGDEN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	15950	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346001575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH SUGDEN PT

Provider Business Mailing Address
First Line	:	PO BOX 735044
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-5044
Country	:	US
Telephone Number	:	414-747-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 E LAYTON AVE STE 160
Second Line	:
City	:	ST FRANCIS
State	:	WI
Zip	:	53235-6054
Country	:	US
Telephone Number	:	414-747-8400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2024
Last Update Date	:	03/12/2024

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