Provider Demographics
NPI:1467547802
Name:HANSEN, SUZANNE CLAIRE (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:CLAIRE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 MORECROFT ROAD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549
Mailing Address - Country:US
Mailing Address - Phone:925-283-4197
Mailing Address - Fax:
Practice Address - Street 1:1 BATES BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2800
Practice Address - Country:US
Practice Address - Phone:925-254-8755
Practice Address - Fax:925-254-7519
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist