Provider Demographics
NPI:1083830640
Name:HANSEN, KRISTIN (PT)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
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 1:328 CERRITOS AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3430
Mailing Address - Country:US
Mailing Address - Phone:562-436-6991
Mailing Address - Fax:562-436-9331
Practice Address - Street 1:2031 E ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6723
Practice Address - Country:US
Practice Address - Phone:714-279-6001
Practice Address - Fax:714-279-6025
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6755225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist