Provider Demographics
NPI:1295463297
Name:HANSEN, JULIA ALEXANDRA
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ALEXANDRA
Last Name:HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-2025
Mailing Address - Country:US
Mailing Address - Phone:860-391-9944
Mailing Address - Fax:
Practice Address - Street 1:1 TOWNE PARK PLZ
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2247
Practice Address - Country:US
Practice Address - Phone:860-886-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14.013649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist