Provider Demographics
NPI:1043415441
Name:HANSEN, CRAIG ALEXANDER I
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ALEXANDER
Last Name:HANSEN
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-1905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:92 MONTVALE AVE
Practice Address - Street 2:STE 1400
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3629
Practice Address - Country:US
Practice Address - Phone:617-591-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA90822251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic