Provider Demographics
NPI:1053839902
Name:WALEK, HANNAH MAE (MS, LAT, ATC)
Entity type:Individual
Prefix:MISS
First Name:HANNAH
Middle Name:MAE
Last Name:WALEK
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:MAE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, ATC, LAT
Mailing Address - Street 1:446 PONY EXPRESS TRL
Mailing Address - Street 2:
Mailing Address - City:AULT
Mailing Address - State:CO
Mailing Address - Zip Code:80610-9771
Mailing Address - Country:US
Mailing Address - Phone:970-775-4597
Mailing Address - Fax:
Practice Address - Street 1:901 W PLUM ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-1186
Practice Address - Country:US
Practice Address - Phone:970-775-4597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00023442255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer