Provider Demographics
NPI:1669732483
Name:HANNAN, PAULINE (DPT)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:HANNAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 S MAIN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3528
Mailing Address - Country:US
Mailing Address - Phone:509-430-4616
Mailing Address - Fax:
Practice Address - Street 1:856 S MAIN ST UNIT B
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3528
Practice Address - Country:US
Practice Address - Phone:509-430-4616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-26
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2702225100000X
UT10152248-2401208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist