Provider Demographics
NPI:1780896647
Name:HANSON, TEENA (PT)
Entity type:Individual
Prefix:
First Name:TEENA
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TEENA
Other - Middle Name:
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6941
Mailing Address - Fax:217-344-8047
Practice Address - Street 1:2300 N. VERMILLON AVE.
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1735
Practice Address - Country:US
Practice Address - Phone:217-431-7930
Practice Address - Fax:217-344-8047
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203OtherBLUE CROSS PROV ID
IL4117OtherHAMP PROVIDER ID
7216OtherPERSONALCARE PROV ID
113326OtherHEALTHLINK PROV ID
IL203OtherBLUE CROSS PROV ID