Provider Demographics
NPI:1659029551
Name:HANSEN, JENNIFER WARRINER (PTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WARRINER
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 ROLLING MIST CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4405
Mailing Address - Country:US
Mailing Address - Phone:678-612-6583
Mailing Address - Fax:
Practice Address - Street 1:3330 PRESTON RIDGE RD STE 240
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4540
Practice Address - Country:US
Practice Address - Phone:770-740-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA001303225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant