Provider Demographics
NPI:1790302925
Name:HANSON PHYSICAL THERAPY & SPORTS PERFORMANCE
Entity Type:Organization
Organization Name:HANSON PHYSICAL THERAPY & SPORTS PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:703-407-4881
Mailing Address - Street 1:2505 REVERE CT
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-3253
Mailing Address - Country:US
Mailing Address - Phone:703-407-4881
Mailing Address - Fax:
Practice Address - Street 1:750 STATE ROUTE 3 S STE 5
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1306
Practice Address - Country:US
Practice Address - Phone:703-407-4881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBX02-0002OtherBCBS