Provider Demographics
NPI:1356815245
Name:HANSON, ERIC ROBERT (MSAT, ATC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ROBERT
Last Name:HANSON
Suffix:
Gender:M
Credentials:MSAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14545 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2774
Mailing Address - Country:US
Mailing Address - Phone:612-384-1623
Mailing Address - Fax:
Practice Address - Street 1:14545 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2774
Practice Address - Country:US
Practice Address - Phone:612-384-1623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNUUA216A24781OtherBLUECROSS BLUESHIELD