Provider Demographics
NPI:1689976102
Name:HANSEN, MICHELLE ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANNE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 10TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3420
Mailing Address - Country:US
Mailing Address - Phone:619-437-6450
Mailing Address - Fax:619-437-6672
Practice Address - Street 1:1224 10TH ST STE 204
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-3420
Practice Address - Country:US
Practice Address - Phone:619-437-6450
Practice Address - Fax:619-437-6672
Is Sole Proprietor?:No
Enumeration Date:2010-12-04
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist