Provider Demographics
NPI:1225141070
Name:HANSON, LELAND S (LAT, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:LELAND
Middle Name:S
Last Name:HANSON
Suffix:
Gender:M
Credentials:LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 CRYSTAL LANTERN DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7004
Mailing Address - Country:US
Mailing Address - Phone:702-445-1434
Mailing Address - Fax:
Practice Address - Street 1:601 WHITNEY RANCH DR STE B6
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2643
Practice Address - Country:US
Practice Address - Phone:702-434-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05060292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer