Provider Demographics
NPI:1891784419
Name:HANSSEN, MARTHA Z (PT)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:Z
Last Name:HANSSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1169
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78680-1169
Mailing Address - Country:US
Mailing Address - Phone:512-388-1448
Mailing Address - Fax:512-388-7854
Practice Address - Street 1:16020 PARK VALLEY DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3573
Practice Address - Country:US
Practice Address - Phone:512-388-1448
Practice Address - Fax:512-388-7854
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1054260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1054260OtherPHYSICAL THERAPY EXAMINER