Provider Demographics
NPI:1780341651
Name:HANSEN, ELIZABETH AMI (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:AMI
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 DELANCEY WAY
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-8513
Mailing Address - Country:US
Mailing Address - Phone:609-238-9254
Mailing Address - Fax:
Practice Address - Street 1:698 MULLICA HILL RD STE 140
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-4453
Practice Address - Country:US
Practice Address - Phone:856-508-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01718600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist