Active NPI
Dawn Marie Hannon, PTA
- Physical Therapy Assistant
- Kenosha, WI
National Provider Identifier
1902178890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 1785-019
- Practice address
- 1519 60TH Street
Kenosha, WI 53140-3954 - Phone
- (262) 656-7500
- Fax
- (262) 656-7500
- NPI assigned
- Feb 7, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 1785-019 | WI | Primary |
Addresses
Primary practice location
1519 60TH Street
Kenosha, WI 53140-3954
Mailing address
6018 8TH Avenue Apt.1
Kenosha, WI 53143
Phone (262) 412-8265
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1785-019 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447718400000",
"number": "1902178890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6018 8TH AVENUE APT.1",
"city": "KENOSHA",
"state": "WI",
"postal_code": "53143",
"telephone_number": "262-412-8265"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1519 60TH STREET",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531403954",
"telephone_number": "262-656-7500",
"fax_number": "262-656-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANNON",
"first_name": "DAWN",
"middle_name": "MARIE",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-07",
"last_updated": "2015-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "1785-019",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.