Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 25287 | MD |
N | 2251X0800X | Physical Therapist - Orthopedic | PT024126 | PA |
NPI | 1023416989 |
---|---|
Provider Name | Mr. Matthew Hannan |
First Address | Gaithersburg, MD 20878 |
Second Address | Gaithersburg, MD 20878 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2014 |
Last Update Date | 09/02/2016 |