Individual
JENNIFER HANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3614 PROVIDENCE RD S STE 100, WAXHAW, NC 28173-6310
(704) 384-8640
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-8640
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
0012454
CO
225100000X
Physical Therapist
035573
NY
225100000X
Physical Therapist
1240660
TX
225100000X
Physical Therapist
Primary
14634
NC
Other
Enumeration date
06/04/2014
Last updated
10/28/2020
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