Provider Demographics
NPI:1265457808
Name:HANSEN, ANNA MARIE (MSPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3287
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3287
Mailing Address - Country:US
Mailing Address - Phone:503-489-1174
Mailing Address - Fax:503-489-1650
Practice Address - Street 1:213 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:MYRTLE CREEK
Practice Address - State:OR
Practice Address - Zip Code:97457
Practice Address - Country:US
Practice Address - Phone:541-863-8401
Practice Address - Fax:541-863-8403
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR130647Medicare PIN
ORR145013Medicare PIN