Provider Demographics
NPI:1790355998
Name:HANSON, TERESA MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:HANSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 WILLOW LN SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-1809
Mailing Address - Country:US
Mailing Address - Phone:507-358-8214
Mailing Address - Fax:
Practice Address - Street 1:210 GRAND AVE E
Practice Address - Street 2:
Practice Address - City:GRAND MEADOW
Practice Address - State:MN
Practice Address - Zip Code:55936-2600
Practice Address - Country:US
Practice Address - Phone:507-358-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA1932225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA1932OtherPHYSICAL THERAPIST ASSISTANT