Provider Demographics
NPI:1083819346
Name:HANSEN, RHONDA JOLEEN (PT)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:JOLEEN
Last Name:HANSEN
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 1:115 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365-2037
Mailing Address - Country:US
Mailing Address - Phone:940-538-5604
Mailing Address - Fax:
Practice Address - Street 1:211 E JASPER ST
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TX
Practice Address - Zip Code:76458-1848
Practice Address - Country:US
Practice Address - Phone:940-567-3924
Practice Address - Fax:940-567-3924
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10927322251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics