Provider Demographics
NPI:1871116723
Name:TUSTIN, HANNAH E (PT)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:E
Last Name:TUSTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28345 OLD TARBY RD
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-7167
Mailing Address - Country:US
Mailing Address - Phone:405-837-8909
Mailing Address - Fax:
Practice Address - Street 1:28345 OLD TARBY RD
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-7167
Practice Address - Country:US
Practice Address - Phone:405-837-8909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist