Provider Demographics
NPI:1578999447
Name:HANSEN, JUDITH (PT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11351 JAMES WATT DR
Mailing Address - Street 2:STE. A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6627
Mailing Address - Country:US
Mailing Address - Phone:915-849-6602
Mailing Address - Fax:915-849-6603
Practice Address - Street 1:11351 JAMES WATT DR
Practice Address - Street 2:STE. A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6627
Practice Address - Country:US
Practice Address - Phone:915-849-6602
Practice Address - Fax:915-849-6603
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1229790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist