Provider Demographics
NPI:1477977395
Name:HANSON, TERESA (PTA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 LINDA LOU DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-5526
Mailing Address - Country:US
Mailing Address - Phone:561-202-5305
Mailing Address - Fax:561-963-6923
Practice Address - Street 1:1523 LINDA LOU DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-5526
Practice Address - Country:US
Practice Address - Phone:561-202-5305
Practice Address - Fax:561-963-6923
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24678225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant