Provider Demographics
NPI:1548388853
Name:HANNA, DOUGLAS LEN (MS PT)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:LEN
Last Name:HANNA
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3020 CARBON PL
Mailing Address - Street 2:STE 330
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-6169
Mailing Address - Country:US
Mailing Address - Phone:303-579-2310
Mailing Address - Fax:
Practice Address - Street 1:3020 CARBON PL STE 330
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-6148
Practice Address - Country:US
Practice Address - Phone:303-938-1141
Practice Address - Fax:303-938-1311
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO3177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO445008Medicare PIN