Provider Demographics
NPI:1881423424
Name:HANSON, JEFFEREY MICHAEL
Entity type:Individual
Prefix:
First Name:JEFFEREY
Middle Name:MICHAEL
Last Name:HANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 N 1570 W
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5316
Mailing Address - Country:US
Mailing Address - Phone:801-898-0669
Mailing Address - Fax:
Practice Address - Street 1:272 E CENTER ST STE 103
Practice Address - Street 2:
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6743
Practice Address - Country:US
Practice Address - Phone:435-674-2115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT820009498019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant