Provider Demographics
NPI:1174634141
Name:HANNA, INGRID MARIE (MSPT)
Entity type:Individual
Prefix:MS
First Name:INGRID
Middle Name:MARIE
Last Name:HANNA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:HANNA
Other - Middle Name:PHYSICAL
Other - Last Name:THERAPY, PLLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:34 DALE RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3659
Mailing Address - Country:US
Mailing Address - Phone:860-678-8655
Mailing Address - Fax:860-678-7335
Practice Address - Street 1:34 DALE RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3659
Practice Address - Country:US
Practice Address - Phone:860-678-8655
Practice Address - Fax:860-678-7335
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215199225100000X
TX1145688225100000X
CT014158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist