Provider Demographics
NPI:1821328212
Name:HANSON, KIMBERLY DENISE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DENISE
Last Name:HANSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:HANSON
Other - Last Name:BORRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:20410 CENTURY BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1186
Mailing Address - Country:US
Mailing Address - Phone:301-540-6140
Mailing Address - Fax:301-540-5190
Practice Address - Street 1:9501 OLD ANNAPOLIS RD
Practice Address - Street 2:DORSEY HALL MEDICAL CENTER, SUITE 125
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6314
Practice Address - Country:US
Practice Address - Phone:410-997-1063
Practice Address - Fax:410-997-1408
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD182132821Medicaid
MD182132821OtherMEDICARE