Provider Demographics
NPI:1922009695
Name:HANSON, TYLER M (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:M
Last Name:HANSON
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 E SOUTH TEMPLE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1206
Mailing Address - Country:US
Mailing Address - Phone:801-512-2656
Mailing Address - Fax:801-906-0336
Practice Address - Street 1:370 E SOUTH TEMPLE
Practice Address - Street 2:SUITE 250
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1206
Practice Address - Country:US
Practice Address - Phone:801-512-2656
Practice Address - Fax:801-906-0336
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT360816-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT69157OtherPEHP
UT870388269BR1OtherEDUCATORS MUTUAL
UTQM0000061055OtherALTIUS
UT5417OtherDMBA
UT6400593OtherUNITED HEALTHCARE
UTCJ9402OtherRAILROAD MEDICARE
UTQM0000061055OtherALTIUS
UT5417OtherDMBA