Provider Demographics
NPI:1841344066
Name:HANSON, ELLEN M (PT)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:M
Last Name:HANSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:M
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:307 DRIVE C
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1737
Mailing Address - Country:US
Mailing Address - Phone:607-738-3804
Mailing Address - Fax:
Practice Address - Street 1:307 DRIVE C
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1737
Practice Address - Country:US
Practice Address - Phone:607-738-3804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016246-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist