Provider Demographics
NPI:1700219425
Name:HANSON, HEATHER LYNN (PT, DPT, PCS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:HANSON
Suffix:
Gender:F
Credentials:PT, DPT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BRANCH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4309
Mailing Address - Country:US
Mailing Address - Phone:617-571-0911
Mailing Address - Fax:
Practice Address - Street 1:55 BRANCH AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4309
Practice Address - Country:US
Practice Address - Phone:617-571-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018392225100000X
DEJ1-0002616225100000X
NJ40QA01295500225100000X
NY035966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist