Provider Demographics
NPI:1710853395
Name:HANSEN, TRAVIS L (PRS)
Entity type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:L
Last Name:HANSEN
Suffix:
Gender:M
Credentials:PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56351 COUNTY ROAD 21
Mailing Address - Street 2:
Mailing Address - City:MAZEPPA
Mailing Address - State:MN
Mailing Address - Zip Code:55956-4175
Mailing Address - Country:US
Mailing Address - Phone:507-226-1824
Mailing Address - Fax:
Practice Address - Street 1:56351 COUNTY ROAD 21
Practice Address - Street 2:
Practice Address - City:MAZEPPA
Practice Address - State:MN
Practice Address - Zip Code:55956-4175
Practice Address - Country:US
Practice Address - Phone:507-226-1824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty