Provider Demographics
NPI:1205694395
Name:DR HANSCOM MOBILE PT
Entity type:Organization
Organization Name:DR HANSCOM MOBILE PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSCOM
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:610-554-2922
Mailing Address - Street 1:1106 SUMMERHILL DR
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-8711
Mailing Address - Country:US
Mailing Address - Phone:610-554-2922
Mailing Address - Fax:
Practice Address - Street 1:1106 SUMMERHILL DR
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-8711
Practice Address - Country:US
Practice Address - Phone:610-554-2922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy