Provider Demographics
NPI:1033310842
Name:HANSEN, RODERICK E (PT)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:E
Last Name:HANSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 COUNTY ROAD 520
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1059
Mailing Address - Country:US
Mailing Address - Phone:732-946-2101
Mailing Address - Fax:
Practice Address - Street 1:475 COUNTY ROAD 520
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-1059
Practice Address - Country:US
Practice Address - Phone:732-946-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00461900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094371Medicare ID - Type Unspecified