Provider Demographics
NPI:1902509847
Name:HANNAH, STEPHANIE JOANN (PT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOANN
Last Name:HANNAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:JOANN
Other - Last Name:FERNANDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:54 BEACON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2793
Mailing Address - Country:US
Mailing Address - Phone:224-388-0001
Mailing Address - Fax:
Practice Address - Street 1:54 BEACON ST APT 1
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2793
Practice Address - Country:US
Practice Address - Phone:224-388-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty