Provider Demographics
NPI:1801032032
Name:HANSEN, AUDREY LEAH (BS, LMT)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LEAH
Last Name:HANSEN
Suffix:
Gender:F
Credentials:BS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 E DUCATI WAY
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790
Mailing Address - Country:US
Mailing Address - Phone:435-669-7099
Mailing Address - Fax:435-674-4681
Practice Address - Street 1:300 NORTH 200 EAST
Practice Address - Street 2:SUITE 2C
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:435-663-7099
Practice Address - Fax:435-674-4681
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist