Provider Demographics
NPI:1629098926
Name:HANSEN, DENISE MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARIE
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 1:3 CALIENTE RD
Mailing Address - Street 2:UNIT 3A
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9209
Mailing Address - Country:US
Mailing Address - Phone:505-466-2500
Mailing Address - Fax:505-466-4959
Practice Address - Street 1:3 CALIENTE RD
Practice Address - Street 2:UNIT 3A
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9209
Practice Address - Country:US
Practice Address - Phone:505-466-2500
Practice Address - Fax:505-466-4959
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2787225100000X
CAPT 12520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist