Provider Demographics
NPI:1417107731
Name:HANSEN, BETHANY NOEL (PT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:NOEL
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:NOEL
Other - Last Name:BECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:7815 3RD ST N STE 203
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5443
Mailing Address - Country:US
Mailing Address - Phone:952-835-4512
Mailing Address - Fax:952-516-5655
Practice Address - Street 1:3912 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-4709
Practice Address - Country:US
Practice Address - Phone:952-835-4512
Practice Address - Fax:952-516-5655
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist