Provider Demographics
NPI:1003838640
Name:HANSEN, COURTNEY L (MPT)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:L
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:535 E MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3424
Mailing Address - Country:US
Mailing Address - Phone:307-335-3471
Mailing Address - Fax:307-332-5388
Practice Address - Street 1:535 E MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3424
Practice Address - Country:US
Practice Address - Phone:307-335-3471
Practice Address - Fax:307-332-5388
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT8472251S0007X, 2251X0800X, 225100000X, 2251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY307984OtherBLUE CROSS BLUE SHIELD
WY114469300Medicaid
WY650017698OtherRAILROAD MEDICARE