Provider Demographics
NPI:1457975229
Name:HANSEN PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:HANSEN PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:773-808-8788
Mailing Address - Street 1:136 N PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3347
Mailing Address - Country:US
Mailing Address - Phone:773-808-8788
Mailing Address - Fax:
Practice Address - Street 1:1 KENNEDY DR # U3-4
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7152
Practice Address - Country:US
Practice Address - Phone:802-863-3323
Practice Address - Fax:802-863-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy