Provider Demographics
NPI:1356806178
Name:HANSON, CRAIG ROYCE (PT)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:ROYCE
Last Name:HANSON
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 1:1633 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3033
Mailing Address - Country:US
Mailing Address - Phone:325-672-4372
Mailing Address - Fax:
Practice Address - Street 1:2371 CROCKETT DRIVE
Practice Address - Street 2:STE 104
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-6047
Practice Address - Country:US
Practice Address - Phone:325-430-6319
Practice Address - Fax:325-430-6320
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1133122225100000X
225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant