Individual
HANNAH TEAL WIRTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
1760 E KEN PRATT BLVD STE 405, LONGMONT, CO 80504-5311
(720) 718-5400
(720) 718-5991
Mailing address
1760 E KEN PRATT BLVD STE 405, LONGMONT, CO 80504-5311
(720) 718-5400
(720) 718-5991
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT60559764
WA
225100000X
Physical Therapist
Primary
PTL.0018748
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0349709
WA L&I
WA
05
—
1689050049
—
WA
Enumeration date
08/07/2015
Last updated
11/23/2022
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