Provider Demographics
NPI:1508210113
Name:HANSON, LORI ANN (PTA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
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 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:1453 RIVERSTONE PKWY
Practice Address - Street 2:STE 170
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30014-5603
Practice Address - Country:US
Practice Address - Phone:770-704-0774
Practice Address - Fax:770-704-0779
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003270225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant