Provider Demographics
NPI:1528215712
Name:HANSEN, CANDICE MORGAN (PT)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:MORGAN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CANDICE
Other - Middle Name:MORGAN
Other - Last Name:REASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:327 N 17TH AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4285
Mailing Address - Country:US
Mailing Address - Phone:715-845-2942
Mailing Address - Fax:715-842-3416
Practice Address - Street 1:327 N 17TH AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4285
Practice Address - Country:US
Practice Address - Phone:715-845-2942
Practice Address - Fax:715-842-3416
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10572-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist