Provider Demographics
NPI:1356494181
Name:HANSEN, BECKY MARA (PT, NCS)
Entity Type:Individual
Prefix:MRS
First Name:BECKY
Middle Name:MARA
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PT, NCS
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:MARA
Other - Last Name:KERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:325 9TH AVENUE, BOX 359859
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2499
Mailing Address - Country:US
Mailing Address - Phone:206-744-4238
Mailing Address - Fax:206-744-2756
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3486KEOtherBLUE SHIELD#
WA0039622OtherLABOR AND INDUSTRIES #