Provider Demographics
NPI:1780866327
Name:HANSON, MATHU NATAKI (PT, DPT, MBA)
Entity Type:Individual
Prefix:DR
First Name:MATHU
Middle Name:NATAKI
Last Name:HANSON
Suffix:
Gender:M
Credentials:PT, DPT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11762 DE PALMA RD STE 1C-492
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-4010
Mailing Address - Country:US
Mailing Address - Phone:951-479-2139
Mailing Address - Fax:951-254-9928
Practice Address - Street 1:4300 GREEN RIVER RD STE 114
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-1506
Practice Address - Country:US
Practice Address - Phone:951-382-4238
Practice Address - Fax:951-254-9928
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist