MEDICARE: HANNAH RENEE WADE PT, DPT

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	1354657	TX
2	225100000X	Physical Therapist	008503	KY

General Provider Information

NPI Number	:	1417612284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH RENEE WADE PT, DPT

Provider Business Mailing Address
First Line	:	52 STATION BRANCH EST
Second Line	:
City	:	PRESTONSBURG
State	:	KY
Zip	:	41653-2108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	843 EASTERN BYP STE 3
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2569
Country	:	US
Telephone Number	:	859-544-1770
Fax Number	:	859-310-7191

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

Provider Enumeration Date	:	11/05/2021
Last Update Date	:	09/08/2022

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