Provider Demographics
NPI:1780668665
Name:HANS, MARK CHRISTOPHER (PT, MPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:HANS
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23100 EUCALYPTUS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5439
Mailing Address - Country:US
Mailing Address - Phone:858-775-7820
Mailing Address - Fax:951-379-1501
Practice Address - Street 1:26755 JEFFERSON AVE STE D-1
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8924
Practice Address - Country:US
Practice Address - Phone:951-574-6300
Practice Address - Fax:951-574-6301
Is Sole Proprietor?:No
Enumeration Date:2005-12-03
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT230200OtherBLUE SHIELD OF CALIFORNIA
CA0PT230201OtherMEDICARE PTAN