Provider Demographics
NPI:1497027338
Name:HANSON, ADAM J
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:J
Last Name:HANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ADAM
Other - Middle Name:J
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:2915 NORTH MEADE STREET
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911
Mailing Address - Country:US
Mailing Address - Phone:920-993-6837
Mailing Address - Fax:920-993-6843
Practice Address - Street 1:2915 N MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1509
Practice Address - Country:US
Practice Address - Phone:920-993-6837
Practice Address - Fax:920-993-6843
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1831-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant