Provider Demographics
NPI:1427370584
Name:HANSON, CARRIE LYN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LYN
Last Name:HANSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:VERMILLION
Mailing Address - State:SD
Mailing Address - Zip Code:57069-2602
Mailing Address - Country:US
Mailing Address - Phone:605-624-7246
Mailing Address - Fax:605-624-7177
Practice Address - Street 1:1407 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:VERMILLION
Practice Address - State:SD
Practice Address - Zip Code:57069-2602
Practice Address - Country:US
Practice Address - Phone:605-624-7246
Practice Address - Fax:605-624-7177
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist