Provider Demographics
NPI:1588185136
Name:HANSEN, RACQUEL LYN (ATC)
Entity Type:Individual
Prefix:
First Name:RACQUEL
Middle Name:LYN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 N 2750 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-5111
Mailing Address - Country:US
Mailing Address - Phone:801-822-6187
Mailing Address - Fax:
Practice Address - Street 1:173 RB
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84602-2000
Practice Address - Country:US
Practice Address - Phone:801-422-1628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer