Provider Demographics
NPI:1629234083
Name:HANSEN, LAURA A (PT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
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 1:535 SYLMAR CT
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-6707
Mailing Address - Country:US
Mailing Address - Phone:559-273-1001
Mailing Address - Fax:559-297-8812
Practice Address - Street 1:2555 S EAST AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-5104
Practice Address - Country:US
Practice Address - Phone:559-445-0606
Practice Address - Fax:559-264-9241
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist