Provider Demographics
NPI:1700838463
Name:HANNER, TONYA S (PT)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:S
Last Name:HANNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:S
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5298 N COUNTY ROAD 1100E
Mailing Address - Street 2:
Mailing Address - City:LERNA
Mailing Address - State:IL
Mailing Address - Zip Code:62440-2211
Mailing Address - Country:US
Mailing Address - Phone:217-663-5203
Mailing Address - Fax:
Practice Address - Street 1:5298 N COUNTY ROAD 1100E
Practice Address - Street 2:
Practice Address - City:LERNA
Practice Address - State:IL
Practice Address - Zip Code:62440-2211
Practice Address - Country:US
Practice Address - Phone:217-663-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-014947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK49062Medicare PIN
ILK49063Medicare PIN