Provider Demographics
NPI:1184159469
Name:BLYDT-HANSEN, EIRIK CHRISTIAN (PT)
Entity type:Individual
Prefix:MR
First Name:EIRIK
Middle Name:CHRISTIAN
Last Name:BLYDT-HANSEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 IMPERIAL HWY
Mailing Address - Street 2:PHYSICAL THERAPY DEPARTMENT
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3456
Mailing Address - Country:US
Mailing Address - Phone:562-385-6799
Mailing Address - Fax:562-384-6052
Practice Address - Street 1:7601 IMPERIAL HWY
Practice Address - Street 2:PHYSICAL THERAPY DEPARTMENT
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3456
Practice Address - Country:US
Practice Address - Phone:562-385-6799
Practice Address - Fax:562-384-6052
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist