Provider Demographics
NPI:1407162027
Name:HANSON, AILEEN SHERRIN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:AILEEN
Middle Name:SHERRIN
Last Name:HANSON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1217 S GREELEY HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-3064
Mailing Address - Country:US
Mailing Address - Phone:307-772-0955
Mailing Address - Fax:307-772-0953
Practice Address - Street 1:1217 S GREELEY HWY
Practice Address - Street 2:SUITE A
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-3064
Practice Address - Country:US
Practice Address - Phone:307-772-0955
Practice Address - Fax:307-772-0953
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO2711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYPTANW23699Medicare UPIN