Provider Demographics
NPI:1760966709
Name:HANSEN, HEATHER JAYNE (PT,DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JAYNE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 COURT ST APT 8
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6428
Mailing Address - Country:US
Mailing Address - Phone:818-601-6801
Mailing Address - Fax:
Practice Address - Street 1:194 JORALEMON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4312
Practice Address - Country:US
Practice Address - Phone:718-643-7116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-15
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043036225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist