Provider Demographics
NPI:1497210777
Name:HANSEN, BRADLEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:HANSEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 N 1200 W STE A
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1937
Mailing Address - Country:US
Mailing Address - Phone:801-675-0608
Mailing Address - Fax:801-776-3087
Practice Address - Street 1:2369 N 400 E
Practice Address - Street 2:
Practice Address - City:NORTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84414-7232
Practice Address - Country:US
Practice Address - Phone:801-728-4624
Practice Address - Fax:801-776-3087
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist