Provider Demographics
NPI:1649370701
Name:HANSEN, JAMES ERIC (MPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ERIC
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18059 HIGHWAY 105 W STE 105
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5001
Mailing Address - Country:US
Mailing Address - Phone:936-582-5633
Mailing Address - Fax:936-582-5634
Practice Address - Street 1:18059 HIGHWAY 105 W STE 105
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5001
Practice Address - Country:US
Practice Address - Phone:936-582-5633
Practice Address - Fax:936-582-5634
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1149577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T4600OtherBCBS I.D.
TX8G1870Medicare ID - Type Unspecified