Provider Demographics
NPI:1699176644
Name:HANSON, ADRIENNE LEIGH (PT DPT OCS)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:LEIGH
Last Name:HANSON
Suffix:
Gender:F
Credentials:PT DPT OCS
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:LEIGH
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT OCS
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31515 RANCHO PUEBLO RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4837
Practice Address - Country:US
Practice Address - Phone:951-303-1414
Practice Address - Fax:951-303-1616
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41606225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic