Provider Demographics
NPI:1346253127
Name:HANSEN, ROBERTA LOUISE (PT, MS)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:LOUISE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:102 N WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6542
Mailing Address - Country:US
Mailing Address - Phone:847-255-0120
Mailing Address - Fax:847-310-9167
Practice Address - Street 1:1835 W CENTRAL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2410
Practice Address - Country:US
Practice Address - Phone:847-255-0120
Practice Address - Fax:847-310-9167
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist