Provider Demographics
NPI:1073618773
Name:HANSON, JAN (PT)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SCHOONER CT
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9295
Mailing Address - Country:US
Mailing Address - Phone:651-436-2362
Mailing Address - Fax:651-730-1121
Practice Address - Street 1:670 COMMERCE DR STE 140
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9290
Practice Address - Country:US
Practice Address - Phone:651-501-2010
Practice Address - Fax:651-436-6775
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8852251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6403663OtherMEDICA
MN487001000OtherUS DEPT OF LABOR
MN034M0HAOtherMN BCBS
MN139319700Medicaid