Basic Information
| Provider Information | |||||||||
| NPI: | 1922555473 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUALTIERI | ||||||||
| FirstName: | HANNAH | ||||||||
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| Credential: | AT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1302 HONEYSUCKLE DR | ||||||||
| Address2: | |||||||||
| City: | FAIRBORN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453245906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376268675 | ||||||||
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| Practice Location | |||||||||
| Address1: | MIAMI VALLEY DRIVE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | CENTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372088000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2016 | ||||||||
| LastUpdateDate: | 09/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 004975 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.