Provider Demographics
NPI:1780677195
Name:HANSEN, SETH ROBERT (MS, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:ROBERT
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MS, ATC, CSCS
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:96 LONGVIEW LN
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-6929
Mailing Address - Country:US
Mailing Address - Phone:301-387-2691
Mailing Address - Fax:304-788-6871
Practice Address - Street 1:101 FORT AVE
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2600
Practice Address - Country:US
Practice Address - Phone:304-788-6880
Practice Address - Fax:304-788-6871
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer