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NPI Code Detail

MEDICARE: ALLAN JAMES HANABURGH PT

MEDICARE: ALLAN JAMES HANABURGH 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
1225100000XPhysical Therapist021706NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1107786FTOTHERNYPREFERRED CARE

General Provider Information

NPI Number : 1912972480
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLAN JAMES HANABURGH PT
Provider Business Mailing Address
First Line : 92 WEST AVE
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-1306
Country : US
Telephone Number : 585-637-0790
Fax Number : 585-637-3572
Provider Business Practice Location Address
First Line : 92 WEST AVE
Second Line :
City : BROCKPORT
State : NY
Zip : 14420-1306
Country : US
Telephone Number : 585-637-0790
Fax Number : 585-637-3572
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2006
Last Update Date : 07/08/2007

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