Provider Demographics
NPI:1245740760
Name:HANSON, JUDITH THOMPSON (PT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:THOMPSON
Last Name:HANSON
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 1:3017 CYPRESS SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-1313
Mailing Address - Country:US
Mailing Address - Phone:410-802-4762
Mailing Address - Fax:
Practice Address - Street 1:3017 CYPRESS SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-1313
Practice Address - Country:US
Practice Address - Phone:410-802-4762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist