Provider Demographics
NPI:1104395540
Name:HANSON, ANNE MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:HANSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 93RD AVE NE APT 208
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6138
Mailing Address - Country:US
Mailing Address - Phone:425-505-8840
Mailing Address - Fax:
Practice Address - Street 1:18560 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-2148
Practice Address - Country:US
Practice Address - Phone:206-393-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60827700225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant