Provider Demographics
NPI:1952330292
Name:HANSEN, KRISTIN DAWN (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DAWN
Last Name:HANSEN
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 1:119 WOODVALE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3520
Mailing Address - Country:US
Mailing Address - Phone:718-984-2516
Mailing Address - Fax:
Practice Address - Street 1:226 MIDDLE RAOD
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730
Practice Address - Country:US
Practice Address - Phone:732-888-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA01167600225100000X
NY027167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist