Provider Demographics
NPI:1073819264
Name:HANSEN, CHASE N (DPT)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:N
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13070 N LEWIS RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-2605
Mailing Address - Country:US
Mailing Address - Phone:989-274-0323
Mailing Address - Fax:
Practice Address - Street 1:5460 W ROLLING HILLS DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722-9668
Practice Address - Country:US
Practice Address - Phone:989-272-4500
Practice Address - Fax:989-272-4501
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist