Provider Demographics
NPI:1972752384
Name:HANSON, SARA (PT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SERAPHINA
Other - Middle Name:G
Other - Last Name:NICOLOSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:96 SHEPHERD LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1671
Mailing Address - Country:US
Mailing Address - Phone:207-318-5055
Mailing Address - Fax:
Practice Address - Street 1:7 PLAZA DR
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8996
Practice Address - Country:US
Practice Address - Phone:207-883-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT10682251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics